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You will have several antenatal appointments and scans during your pregnancy.
Your antenatal care is usually provided by a team of midwives. If everything is normal during your pregnancy, you will follow the routine schedule of antenatal appointments.
Women who have had a baby previously will be seen less frequently, women experiencing complications will be seen more often.
If complications arise or if you have a known medical problem, the midwives will refer you to an obstetrician who will then become the lead professional in your care.
The midwife may also refer you to other professional colleagues such as an anaesthetist, physiotherapist, dietician, or psychologist during your pregnancy.
Your schedule of care
You can use the checklists below to monitor your progress through your pregnancy.
Please talk to your midwife if you need more information about your antenatal care schedule.
If you are fewer than eight weeks pregnant, fill in our self-referral form or see your GP to arrange your first appointment with the midwife.
We encourage you to self-refer for maternity care as soon as possible. This is so antenatal screening can be offered in a timely way.
You should also:
• start taking a folic acid supplement if you have not been taking one already
• read up on foods to avoid when pregnant
• start thinking about the screening tests offered in early pregnancy
If you are a smoker, it is important for you to stop smoking for your health and the health of your unborn baby. Find out more about the risks of smoking during pregnancy and how we can help you stop smoking.
You will be asked to complete carbon monoxide testing at each antenatal appointment, using a simple hand-held device where a reading provides us with information regarding any exposure you might have had to this invisible, poisonous gas.
When you are between 10 and 13 weeks pregnant, you will be invited for your first ultrasound scan to determine the expected date your baby will be born. You will also be offered a screening test for Down's syndrome, Edwards’ syndrome and Patau’s syndrome.
At this appointment, your blood pressure will be checked and your urine tested for signs of infection, diabetes and pre-eclampsia. You will be given your blood test results and the results of your ultrasound scan will be discussed with you.
Your midwife will also provide information about antenatal classes and a more detailed discussion about where you will have your baby.
You will also be given information about your second scan. This scan is sometimes called an anomaly scan.
Vaccines
Some vaccines are offered around this time of your pregnancy.
Download the North Central London ICB leaflet on What vaccinations you I have during pregnancy (pdf format).
If this is your first pregnancy, you will see the midwife when you are 25 weeks pregnant. At this appointment your midwife will:
- check your blood pressure
- ask you how frequently your baby is moving
- give you your MATB1 certificate which enables you to claim maternity leave, maternity pay and certain benefits
- discuss the anti-D injection with you. If your blood is rhesus negative, anti-D stops your body from producing antibodies that could affect future pregnancies
When you are 28 weeks pregnant you will see the midwife, who will:
- check your blood pressure
- measure your uterus (womb) in centimetres to assess the growth of your baby
- ask how frequently your baby is moving
- offer you repeat blood tests for haemoglobin (iron) levels and to check whether you have developed antibodies in your blood
- You will be offered a vaccine for Respiratory Syncytial Virus (RSV). This is a common respiratory virus that usually causes mild, cold-like symptoms during the winter months.
It can occur at any age. However, babies under one year of age and older adults are at the greatest risk of hospitalisation with more severe respiratory disease. You can find out more on the NHS website.
At this appointment, your midwife will also discuss your baby feeding choices and ensure you have arranged for antenatal classes if you wish to attend them.
When you are 31 weeks pregnant you will see the midwife, who will:
- check your blood pressure and uterus
- ask how frequently your baby is moving
- discuss any blood test results with you
When you are 36 weeks pregnant you will see the midwife, who will:
- check your blood pressure and uterus
- ask how frequently your baby is moving
- check the position of your baby
- discuss your plans for labour and birth
You will also be given information about recognising early labour and when to call the hospital or midwife.
Your midwife will discuss your plans for feeding and caring for your baby and yourself after birth.
At 38 weeks and 40 weeks pregnant you will see the midwife, who will:
- check your blood pressure and uterus
- ask how frequently your baby is moving
- check the position of your baby
- discuss your options if your baby does not arrive before one week after your due date
When you are 41 weeks pregnant you will see the midwife, who will:
- check your blood pressure and uterus
- ask how frequently your baby is moving
- check the position of your baby
- offer you a ‘membrane sweep’ which may increase the chances of you going into labour naturally
- discuss your options for induction of labour and book you in for around 10 to 12 days after your due date, if you would like this
All expectant mothers will be offered routine antenatal screening tests, which conform to national standards.
Screening aims to identify people who may have an increased chance of a particular condition that could affect them or their baby.
Whether or not to have each test is a personal choice that only you can make.
The screening tests we offer pregnant women look for:
- infectious diseases including HIV, hepatitis B and syphilis (blood test)
- sickle cell and thalassaemia (blood test)
- Down’s syndrome — from 11 weeks and two days to 20 weeks of pregnancy (blood test and scan)
- Edward’s syndrome and Patau’s syndrome — from 11 weeks and two days to 14 weeks and one day of pregnancy (blood test and scan)
The 20-week scan (anomaly scan) takes place between 18 weeks to 20 weeks and six days of pregnancy to look for 11 physical conditions in your baby.
Read the screening tests for you and your baby leaflets before your midwife booking appointment to find out more about the screening tests offered during and after pregnancy. This link is also provided in your booking appointment letter and the information is available in other languages and in easy-to-read format.
If you require a printed copy of this leaflet, you can collect one at your booking appointment where your screening options will be discussed with you.
Screening tests are also offered for babies soon after they are born so they can be given appropriate treatment as quickly as possible if needed. Please see our postnatal care section for more information.
Maternal medicine team
The maternal medicine team provides pregnancy care for those with pre-existing or pregnancy related medical conditions.
It is comprised of a multidisciplinary team of doctors, specialists and midwives with the aim of providing the best standard of care for birthing people and their babies.
At your first appointment, your midwife will collect detailed information about your medical history and will contact the maternal medicine team for further input if necessary.
The team will contact you directly and will plan all the required follow-up appointments for the rest of your pregnancy.
You can also refer yourself, by including details of your medical condition on our self-referral form.
Once you have been referred to the maternal medicine team, your pregnancy care will be shared between doctors and midwives. The frequency of appointments will be tailored according to your condition and your individualised needs.
We work in collaboration with consultants from a wide range of specialities (neurologists, gastroenterologists, oncologists, rheumatologists, neurologists, anaesthetists, obstetric physicians, and obstetricians) and we conduct regular multidisciplinary meetings to discuss the safest management for you and your baby.
The aim of the maternal medicine service across north central London is to make sure those with pre-existing medical conditions have timely access to specialist advice and care at all stages of pregnancy, and to ensure you are seen in the right place at the right time.
Birth options clinic
Our 'birth options' clinics are led by the consultant obstetrician and consultant midwife, who will make a management plan with you for giving birth.
The clinic provides an opportunity for women who have previously had a caesarean section or traumatic birth to explore the birth choices for their current pregnancy.
During this appointment, we will review your previous notes and talk through your birthing experience.
We recommend that all women who have had one previous uncomplicated caesarean section should plan to have a vaginal birth, unless there are other indications for planning an elective caesarean section.
Women who have previously had a caesarean section will usually be seen in the birth options clinic by a senior midwife or obstetrician before 20 weeks of pregnancy, and again later in the pregnancy depending on individual circumstances.
Depending on your medical and obstetric history, or your personal preferences, an elective caesarean section may be recommended for you.
You will be referred to the birth options clinic to discuss your last birth and plan to support the birth this time.
A caesarean section is a major operation and should not be performed unless there is a medical reason, or it is necessary to protect the health of you or your baby. There are serious implications for you and your unborn child at the time of the surgery and for your future health and pregnancies.
We understand that some women have a fear of childbirth or have other reasons for wanting to have a caesarean section. Please notify your named midwife if you would like a caesarean and a birth options appointment will be made.
Birth options clinics are facilitated by a senior medical specialist who will discuss with you the reasons for your request and to explore your options.
We have maternity day assessment units on the 2nd floor of Barnet Hospital and on the 5th floor of the Royal Free Hospital.
Our specialist maternity day assessment units are for women who require additional care, monitoring and treatment during their pregnancy and after birth.
The reasons you may need to attend the day assessment unit include:
- having high blood pressure in pregnancy
- the baby not moving as much as usual during pregnancy
- you are having severe itching during pregnancy
- you are having a problem with a caesarean section wound after the birth
- you are having a problem with the stitches in your perineum after birth
If you have any concerns or would like to know more, you can contact the maternity day assessment unit on 020 7794 0500 ext 65144 (Barnet Hospital) or 020 7794 0500 ext 33846 (Royal Free Hospital).
Opening hours
Barnet Hospital:
- Every day 8am to 11pm
Royal Free Hospital:
- Monday to Friday 10am to 6pm
- Weekends and bank holidays 10am to 5.30pm
Outside of these hours, you will be seen in maternity triage or on the delivery suites.
Our fetal medicine units at the Royal Free Hospital and Barnet Hospital consist of a specialist team made up of fetal medicine consultants and specialist midwives. We offer pregnancy care when there is a concern for the unborn baby.
Our fetal medicine units diagnose and manage:
- chromosomal abnormalities, such as Down's syndrome, Edward’s syndrome and Patau’s syndrome
- diagnostic invasive testing by chorionic villus sampling (CVS) or amniocentesis, to check for genetic or chromosomal conditions
- genetic conditions and genetic syndromes
- structural fetal anomalies
- fetal conditions requiring surgical follow-up after birth
- detection of fetal cardiac anomalies
- fetal growth restriction with the use of ultrasound doppler examination
- high-risk multiple pregnancies
- non-invasive prenatal testing for women with a higher chance screening result
- pregnancies affected by red cell antibody incompatibility
When appropriate, you may be referred to the Fetal Medicine Unit at University College Hospital or the Fetal Cardiac Centre at Great Ormond Street Hospital for Children.
At the Royal Free Hospital, the fetal medicine unit is on the 5th floor and at Barnet Hospital the fetal medicine unit is on level 2 in the Wellhouse Women’s Centre.
If your midwife refers you to either of our units, you will be offered an appointment if you meet the criteria.
At your first appointment, you will be scanned by one of our fetal medicine doctors using the latest ultrasound equipment. Any findings will be discussed with you in detail. We will also help make a clear plan for your future pregnancy care.
Contact the fetal medicine team
Barnet Hospital
Email rf-tr.
Royal Free Hospital
Email: rf-tr.
If you are pregnant with more than one baby, it is called a ‘multiple birth’.
Families who are expecting twins or triplets experience unique challenges that require specialist care — co-ordinating multiple ultrasounds, the input of our fetal medicine unit , consultant appointments, specialist unit referrals and general midwifery care.
With so much information out there, it can be overwhelming for women and our specialist midwives, working alongside three of our consultant obstetricians, are there to support, facilitate and coordinate your care throughout your pregnancy.
Health conditions and pregnancy
Some pregnant women have or develop conditions which can make their pregnancy more complicated than normal.
The Royal Free London specialises in many such conditions, and we will support you throughout your pregnancy.
The Royal Free Hospital provides comprehensive pregnancy care for women with haemophilia and severe bleeding disorders, including care for those trying to get pregnant.
Some women with less severe bleeding disorders will have pregnancy care shared between the Royal Free Hospital specialist clinic and their local maternity unit.
We run a one-stop antenatal clinic at the Royal Free Hospital with a combined team of obstetricians, endocrinologists, specialist nurses and dieticians providing a high standard of care for women with diabetes, thyroid disorders and other endocrine problems.
The clinic is held every Thursday morning and additional telephone contacts are made through the week.
Referrals to this service can be made by GPs, midwives, obstetricians and endocrinologists. Women who know that they have diabetes are encouraged to indicate on the self-referral form so appropriate care can be arranged.
We run a joint clinic providing pregnancy care for women who have had a renal transplant or who are undergoing dialysis.
It combines the expertise of a consultant obstetrician who specialises in maternal medicine and high-risk pregnancy and a consultant nephrologist who specialises in kidney transplant and pregnancy.
Discussion with the relevant specialists before embarking on a pregnancy is very important. Preconception counselling provides an opportunity to discuss the risks and concerns in detail. Advice can be given about the best time to get pregnant in relation to the transplant or renal disease.
During your pregnancy, you will be seen regularly by the consultants in the same clinic to provide the best possible care and planning for your birth.
A small proportion of women will be referred to an anaesthetic clinic during their pregnancy.
The clinic is for mothers who have medical problems that may affect what type of anaesthetic they can have during labour or delivery.
Your doctor or midwife will refer you to this clinic if it is needed.
Most pregnant women give birth to their baby after 37 weeks of pregnancy, called ‘term delivery’, however, a small proportion (1 in 10) of women go into premature labour and give birth to their baby before 37 weeks of pregnancy.
If a baby arrives just a few weeks early then the outcome is generally excellent, but if they arrive a few months or even earlier, then the outlook can be very different.
The preterm birth clinic is run by specialist midwives and doctors and is specifically for pregnant women who are at risk of premature labour. We support women during their pregnancy by close monitoring and providing treatment to try to prevent premature labour.
Your midwife will make a referral to the pre-term birth clinic at your first antenatal appointment if necessary.
Women and birthing people’s bodies go through a lot of changes during pregnancy. But while some bouts of discomfort and irritation can be self-managed, others should be checked out by your GP or midwife:
- Baby’s movements: if at any time you feel your baby is moving around less frequently or slowing down, or has changed the pattern of their movements, please attend the maternity day assessment unit (MDU) immediately.
- Abdominal pain: while it is normal to have slight contractions throughout pregnancy (this is when you feel your stomach contracting and relaxing), if you experience a sudden, sharp ongoing pain that will not go away, please come to come to the MDU immediately.
- Bleeding: whilst bleeding in pregnancy can be normal, it can also be a sign that something is wrong, especially if it is accompanied by pain. If you are 16 weeks or less, please come to the early pregnancy unit (via the emergency department). If you are more than 16 weeks, please attend the MDU immediately.
- Pain when passing urine: this could be a sign of infection which will need treatment. Drink plenty of fluid and contact your GP within 24 hours.
- Severe itching: while itching is common in pregnancy, severe itching without a rash (particularly in the last four months of pregnancy) can be a sign of a potentially dangerous liver disorder. Call or attend the MDU if you are at all concerned.
- Swollen ankles or hands: normally common, but any sudden changes should be reported to your GP or midwife as it could be a sign of pre-eclampsia — high blood pressure and fluid retention in pregnancy.
- Vaginal discharge: a discharge that is smelly or bloodstained may be an infection and you should be seen by your midwife or GP.
- Headaches or dizziness: may indicate a change in your blood pressure which could be dangerous in pregnancy. Contact the maternity helpline, your named midwife or attend MDU if you are at all concerned.
- Diarrhoea, vomiting or high fever: any sudden ‘acute’ illnesses should be communicated immediately to your GP or midwife.
From around 16 to 24 weeks, you should start to feel your baby move. You should then feel the baby move more and more up until 32 weeks, when it will stay roughly the same until you give birth.
Although a change in your baby’s movements could be nothing to worry about, if you notice a reduction, you should call the maternity unit straight away as this may be a sign that your baby may be unwell. Babies’ movements should not slow down towards the end of pregnancy or during labour.
If your baby’s movements reduce again after your check up, call your maternity team no matter how many times this happens.
Some key things to note are:
- The pattern of your baby’s movements is unique.
- There is no set number of normal movements.
- Get to know your baby’s movements.
- If you think your baby’s movements have slowed down or stopped, speak to your midwife or maternity unit immediately (midwives are available 24 hours a day, seven days a week). There is always a midwife available, even at night. This may be an important warning sign that a baby is unwell.
- Around half of women who had a stillbirth noticed their baby’s movements had slowed down or stopped.
More information is available in English and other languages about your baby’s movements and when to call a midwife at the following links:
MAMA Academy: 'pregnancy essentials' leaflet
MAMA Academy: babies’ movements
Tommy's: 'feeling a baby move is a sign they are well' leaflet
Many of our teams offer antenatal classes within the community, please talk to your midwife for specific details.
We also offer tailored parent education classes for black women, as part of our wider initiatives to reduce health inequalities. For more details, or to book, please visit our Eventbrite page.
If you live out of the area, or prefer an online parenthood class, we offer three workshops to help prepare you for the birth of your baby and beyond.
These are led by a specialist midwife and are delivered via Microsoft Teams. Please click the links below to book your slot for each workshop (morning and afternoon slots available).
Workshop one: becoming a parent
Held on the first Thursday of each month, workshop one is the first of our three-part series, and provides information on where you can have your baby, how to build relationships with your unborn child and links to other sources of important information for you to read.
Workshop two: preparing for birth
Held on the second Thursday of each month, this workshop provides more detailed information on how to prepare for birth, including pre-birth exercises, a list of what to bring into hospital with you, the three stages of labour and how your birth partner can get involved and support you.
Workshop three: infant feeding and caring for your baby
Held on the third Thursday of each month, our final workshop provides you with plenty of information about feeding choices for your baby, skin-to-skin contact, positioning and much more.
How to register for a workshop
- Please visit the links below to book your slot for each workshop. There is a morning and an afternoon slot available for each workshop.
- Once you have accessed the page, you will be asked to register. You will then receive an email confirming your space in the workshop.
- At the time of the workshop, please visit the ‘view the event’ button in the confirmation email and you will be directed to the Microsoft Teams meeting link. Please access this and wait for our parenthood education midwife to admit you into the meeting.
Registration links
- Workshop one: Becoming a parent
- Workshop two: Preparing for birth
- Workshop three: Infant feeding and caring for your baby
We look forward to seeing you there.
Download workshop slides
Please see below the slides that will be presented in each workshop for your viewing:
We offer in-person tours of Barnet Hospital and Royal Free Hospital maternity units. You can book a slot that is convenient for you using the Eventbrite links below.
We request you only bring one partner / companion along. Unfortunately, we cannot accommodate children. During the tour you will have an opportunity to see rooms from all our inpatients areas. During busy times there may be occasions when all rooms are in use and therefore cannot be viewed. Throughout the tour you will be given an opportunity to ask any questions. If you’d like a tour of the Edgware birth centre, please call 020 3758 2434 or email rf.
Barnet Hospital
Royal Free Hospital
The following vaccinations are offered during pregnancy. If you’d like to access these please ask your midwife or GP.
Flu
During pregnancy, your immune system (the body's natural defence) is weakened to protect the pregnancy. This can mean you're less able to fight off infections. As the baby grows, you may be unable to breathe as deeply, increasing the risk of infections such as pneumonia. These changes can raise the risk from flu – pregnant women and birthing people are more likely to get flu complications than women who are not pregnant and are more likely to be admitted to hospital. Having the flu vaccine during the winter months means you're less likely to get flu.
Find out more about the flu jab in pregnancy
Whooping cough
Whooping cough is a very serious infection, and young babies are most at risk. Most babies with whooping cough will be admitted to hospital. When you have the whooping cough vaccination in pregnancy, your body produces antibodies to protect against whooping cough. These antibodies pass to your baby giving them some protection until they're able to have their whooping cough vaccination at 8 weeks old.
Find out more about the whooping cough vaccination in pregnancy
Coronavirus (COVID-19) vaccine
If you're pregnant, or think you might be, it's strongly recommended you get vaccinated against COVID-19 to protect you and your baby. You're at higher risk of getting seriously ill from COVID-19 if you're pregnant. It's safe to have the vaccine during any stage of pregnancy, from the first few weeks up to your expected due date.
You can book your vaccination appointment online.
Find out more about pregnancy and COVID-19 vaccination
Respiratory Syncytial Virus (RSV)
Respiratory Syncytial Virus (RSV) is a common respiratory virus that usually causes mild, cold-like symptoms during the winter months. It can occur at any age. However, babies under one year of age and older adults are at the greatest risk of hospitalisation with more severe respiratory disease. It is a leading cause of infant mortality globally and last year contributed to 34 child deaths in England. The RSV vaccine is offered from 28 weeks. Having the vaccine in week 28 or within a few weeks of this will help you build a good level of antibodies to pass on to your baby before birth. This will give your baby the best protection, including if they are born early.
