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Looking at the mothering, pregnancy, childbirth forums reveals a fair number of members posting the question ‘I’ve got my first visit with the midwife, what will happen?’. I’m going to answer that now, sort of. My slight hesitation is due to the vagaries of how care is provided, everywhere has slight, in some cases major, differences but the interchange of information between the midwife and the pregnant woman will remain the same.

Differences –

  • In some areas the midwife will be the first port of call
  • In other areas the G.P will be the first contact regarding the pregnancy
  • The ”booking’ may be done at home, at the G.P’s, in a Childrens Centre or at the hospital
  • Weirdly, some hospitals have group booking sessions. No idea how this works, confidentiality and all that, most bookings are the midwife, the woman and any other person she consents to have present

Remember that you are entitled to paid time off work for all appointments associated with your pregnancy.

So, you and the midwife have arranged to meet, you are between 8 – 12 weeks pregnant, expect to spend at least 45 minutes on this meeting. You may have been provided with a pack containing booklets and leaflets prior to the meeting, make sure that you have read them as they may provide you with important information about local maternity units, screening tests, diet etc. The pack may also have a blank copy of your maternity notes, if it does then you can make a start filling them in with your name and other personal details. Having read through the information make a note of any questions you want answers to and also any concerns you may have.

Right, so you meet the midwife. She will have lots of questions for you; your previous medical history; about any previous pregnancies; your close family’s medical history regarding diabetes, high blood pressure, miscarriages, stillbirths and also baby’s born with hereditary conditions, abnormalities some of this will also be about baby’s father. Other questions will be about work, alcohol, smoking, recreational drug use, ethnic origin, contact with Social Services and, obscurely, highest educational qualification. At some point screening for Downs Syndrome will be mentioned. The midwife will ensure that you understand all about the tests available and how to access them if you want the screening.  Some areas arrange these for you and some will provide you with the necessary numbers to call. Screening should be available to all on the NHS, you should not have to pay. The midwife will also explain about the blood tests we feel are necessary during pregnancy, she may ask if she can take the blood at this time. There will also be a discussion about where you would like to have your baby, what facilities are offered and the possibility of using a birth unit or having a home birth.

Having listened to your health and social  history the midwife will assess how your care will be provided, whether at this time you fall into the group classed by the hospital as low-risk or whether you need to be seen by an obstetrician. Whichever group you fall into, by the time the midwife leaves you should know the plan for your care and where and when you need to be seen during your pregnancy. At this early time it is difficult to be exact, the midwife can only guesstimate to within 2-3 week windows when the scans will be, and who knows when the consultant appointment will be if you need to see them but she will write down the weeks of pregnancy when you need to be receiving antenatal care and how the appointments are made for these. Information will also be given about the local provision for parentcraft/antenatal classes and contact details given for accessing them. You will also be given the contact details for your midwife and/or her team plus all the local maternity unit numbers.Other topics will include your employment rights during pregnancy, diet, exercise, domestic violence and smoking cessation, you will also receive your form which entitles you to free prescriptions during the pregnancy and until baby is 1 year old. Data protection will be highlighted and the fact it has been discussed will be recorded. I do not discuss labour at this point if it is the first baby but I do cover it following attendance at parentcraft classes and as the end of pregnancy approaches but some midwives may talk about it at this time.

The midwife may test your urine at this time and in some areas a urine specimen will be sent off to be screened for underlying infection. Your blood pressure will also be recorded, along with your weight and height and your BMI calculated. Listening to baby’s heart? Highly unlikely before 12 weeks as baby is still very small and is hidden down below the pubic bone.

By the end of this you may well be suffering from information overload but don’t worry as the midwife will have written everything down in your notes and/or left you leaflets about different topics so you can recap at your leisure!

Here is a link to the NICE Guidelines on Antenatal Care which provide the basis on which your care will be organised.

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I’m not going to blog about the abortion debate. We all have our own beliefs. Enough said.

What has everyone been up to recently? Redundant question really as all the pregnancy bookings I’m wading through at the moment answer that question for me! There is a positive glut of newly pregnant women, November, December and January are going to be busy, busy at our local maternity units.

Over the weekend I booked a woman who lives in one of our old homes, interesting to see what they have done with it. H is 11 weeks pregnant and was suffering extreme nausea, luckily not accompanied by sickness but still very distressing. We had a chat about traditional remedies, drink and a biscuit before you get out of bed, ginger biscuits are recommended, as is ginger beer or ginger itself at any time; anti-nausea wrist-bands; frequent nibbling of biscuits, sweets and, for many women, carbonated drinks. I asked if there were twins in the family, as a multiple pregnancy will produce more pronounced pregnancy symptoms, H was having her scan this morning so we would know soon enough! I reassured her that morning sickness is actually quite a positive sign of a healthy pregnancy, so whilst it is quite debilitating it is also comforting and, will hopefully not continue for more than another few weeks. We carried on with the paperwork and chat, no obvious problems so I quite happily booked H for midwife-led care, mentioning homebirth as a possibility if all continued well with the pregnancy.

Today I had a student nurse out with me on her maternity placement. She was an enthusiastic companion and very eager to find out everything that community midwives get up to. I didn’t have a clinic today but took her into one of my surgeries to pick up any messages and drop off a Maternity Certificate for one of my women to collect. The phlebotomist (blood taker) was there and I checked with her that she knew what to do with the new Family Origin Questionnaires we are using. As we were chatting she told me that H had been in this morning for her blood tests having just returned from her scan. Apparently H was excited, she is having identical twins. I immediately phoned H to congratulate her and her husband and check that all the foundations for her care had been established at the antenatal clinic. They had, in fact H was impressed by how instant the response was when the two babies were seen. H said that when her husband had come home after her booking appointment she had told him about my ‘twin’ comment. When they were having the scan, and could see one baby he had, jokingly, said ‘Oh. Is that another one?’, and as they laughed about it the sonographer told them that it was, apparently their laughter became somewhat hysterical after that. That’s 5, pregnant with twins, women on my books at the moment, and all naturally conceived. 

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