Schedule of maternity care

Weeks	By	Venue	Screening	More Detail
Before	GP	Surgery	Medical and obstetric history. Folate advice. Contraceptive advice.	Folate Contraception What questions
Early	GP	Surgery	Arrange booking (sign form). Folate advice.
10-11	Midwife	Homefield	Risk assessment. Discuss AFP screening. Booking bloods if not having AFP screen.	Paperwork Blood tests
12	Obstetrician or ultrasonographer	RD&E Heavitree	Dating scan
16	Midwife	Homefield	AFP blood test. Booking bloods.	Blood tests
20	Obstetrician or ultrasonographer	RD&E Heavitree	Anomaly scan
25-26	GP or midwife	Homefield	BP check. Urinalysis. Foetal growth. Foetal heart.
28	GP or midwife	Homefield	BP check. Urinalysis. Foetal growth. Foetal heart. Routine bloods.
32	GP or midwife	Homefield	BP check. Urinalysis. Foetal growth. Foetal heart. Routine bloods.
36	GP or midwife	Homefield	BP check. Urinalysis. Foetal growth. Foetal heart.
38	GP or midwife	Homefield	Presentation. BP check. Urinalysis. Foetal growth. Foetal heart.
40	GP or midwife	Homefield	Presentation. BP check. Urinalysis. Foetal growth. Foetal heart. Contraceptive advice.	Breastfeeding advice
41	Obstetrician	RD &E Heavitree	Presentation. BP check. Urinalysis. Foetal growth. Foetal heart. Discuss induction of labour and give date if required.
+6 to 12	GP	Surgery	Postnatal examination. Review of contraceptive advice.

Drugs in Pregnancy (General) | Specific Drugs to avoid or use with caution in Pregnancy

Folate

Folate is a substance which is present in the normal diet in just a little less amounts than is ideal. It is involved in the processes in the development of the baby from a flat plate into a collection of tubular structures. Sufficient Folate makes it less likely that any of the defects involving incomplete closure of these tubes will occur. Particular examples are failure of the bones of the spine to completely close at the back (spina bifida), and failure of the abdomen to close at the front.
Royal College of Obstetricians & Gynaecologists' advice

Contraception

Contraception is a good topic to discuss before having sex, and stopping contraception to get pregnant is part of the discussion of how to use contraception. Whatever method you are using it is sensible to start taking Folate/Folic acid a month before you stop using contraception. If your life is not quite that organised just start taking the folate as soon as you decide you would like to be pregnant and stop using contraception - the benefit may be reduced from not having a whole month beforehand, but quite likely is not, and you may not get pregnant in the first cycle anyway.
With barrier methods just stop. With the pill, there may be a rebound in fertility in the first cycle after you stop, and with ultrasound scans being done routinely to check the dates of the baby the old advice to leave a complete cycle between stopping the pill and getting pregnant seems less useful. It was always as much a matter of convenience in working out the expected date of delivery as anything else.

What matters from medical and obstetric history?

There are at least two reasons for looking at a woman's past general or Obstetric history:-

To allow the clinicians involved to detect who is most likely to have problems and need special care
To alert women to the need for something to be done

Unfortunately the effectiveness of formal scoring methods (asking specific questions about things associated with obstetric problems, and perhaps awarding them points) is strikingly low.
Indeed labelling a woman high risk is probably more likely to harm her than to lead to any change that benefits her, the baby, or except in a defensive legal sense the doctor or midwife involved.

Talk to us about anything in your past that you think may be relevant to the current pregnancy.

Reference: A Guide to Effective Care in Pregnancy & Childbirth, Oxford Medical Publications, ISBN 0 19262324 9 (An excellent book to take to an antenatal clinic appointment with you. Details or buy a copy here).

Measuring Blood Pressure in Pregnancy

Blood pressure recording in all pregnant women reduces the risk of death of mother and child from eclampsia.

Cochrane Foundation abstracts

Paperwork and administration

For historical reasons the funding and administration of Maternity medical Services is separate from General Medical Services.
In order to fund maternity care we require a GMS2 form to be completed as early as possible. (Technically women are not accepted for maternity medical services until this is completed, but any care needed beforehand is not going to be denied because of that, of course)

In exchange for that women receive a form FW8 which declares they are pregnant, and can be exchanged for a form exempting them from prescription charges - take or send it to the Health Authority (The PPSA, Dean Clarke House, Southernhay East, Exeter).

At 26 weeks of the pregnancy, 14 weeks to go, women should collect a Mat B1 form which is required in order to obtain certain maternity benefits, and which employers need sight of to reclaim Statutory Maternity Pay.

Benefits Agency Website

Blood Tests

Syphilis test and blood grouping.

Tests for Chlamydia and HIV recently introduced.

Blood Count. This is sensible, although anaemia at the start of pregnancy is rare nowadays. That is one reason why we no longer give everybody Iron tablets as a routine. A Cochrane Collaboration article abstract discusses this. There seems little benefit in giving Iron and I do not advise it unless the MCV and MCHC are low.

There are no circumstances in which taking the blood at 10 weeks, which was traditional, alters what happens before 15 weeks, so if we are going to take blood at 15-16 weeks we will take the booking blood tests then as well.
If a woman does not want the screening tests at 15-16 weeks we take the other blood tests at the first convenient time, like 10 weeks.

Antibodies: If there are antibodies to the baby's blood group in the mother's blood then they can pass through the placenta and make the baby anaemic. We look for these at various times in the pregnancy and action may be required if they are present.

MCV. Mean Corpuscular Volume. How large the individual red blood cells are. This, and the MCHC (mean corpuscular haemoglobin concentration, how red the cells are) fall if the body is actually short of Iron. Called hypochromic microcytic anaemia.

Revised Feb 2004 (Previous version March 2001)