Written by Dr Amal Kehail
Evidence basis: Based on NICE and WHO guidance on antenatal and postnatal care and on general obstetric practice; general information that does not replace a consultation.
On this page
- Why regular pregnancy checks matter, and how often they happen
- What happens at a routine antenatal check
- The usual blood tests and scans, and when they happen
- Looking after yourself while you are pregnant
- Your own health in the weeks after birth
- What to bring to your pregnancy check-ups
- When to seek urgent help
- Questions patients ask
Why regular pregnancy checks matter, and how often they happen
Most pregnancies progress without problems. Regular checks are there to pick up early the ones that need closer care, often before you notice anything yourself. Pre-eclampsia (high blood pressure in pregnancy affecting other organs) and gestational diabetes, for example, usually cause no symptoms at the start.
The rhythm changes as the pregnancy goes on. There is a longer initial visit, ideally before about 10 weeks. Through the middle months, checks are commonly about four weeks apart. From around 28 weeks they come every two or three weeks, and closer together near the due date.
The World Health Organization recommends at least eight contacts over a pregnancy, and women who have not given birth before usually have a few more. Your own schedule depends on your health, any previous pregnancies and what the checks find.
What happens at a routine antenatal check
The initial visit is the longest. It covers your medical and family history, previous pregnancies and any medicines you take, and your estimated due date is set, usually from the dating scan.
At later checks your blood pressure is measured and your urine is tested for protein, because a rise in either can be an early sign of pre-eclampsia. From about 24 weeks the size of your bump is measured with a tape and plotted on a chart to follow the baby’s growth, and towards the end the baby’s position is checked. You are asked about your mood and sleep too.
The baby’s heartbeat may be heard with a handheld device or seen on a scan. Hearing it is comforting, but it shows how the baby is at that moment, which is why movements between visits matter.
Most women start to feel movements between about 16 and 24 weeks. There is no set number of kicks to count; what matters is your own baby’s usual pattern. Babies do not move less towards the end of pregnancy.
If your baby’s movements slow down, stop, or change from their usual pattern, seek care the same day rather than waiting for the next check.
The usual blood tests and scans, and when they happen
Every test in pregnancy is your choice. Screening tests estimate the chance of a condition rather than diagnosing it, and a higher-chance finding leads to a discussion about further tests. These are the common timings:
- Early blood tests: blood group and rhesus status, a blood count for anaemia, and screening for infections such as hepatitis B, HIV and syphilis, and often for thalassaemia and other inherited blood conditions.
- Dating scan, at around 11 to 14 weeks: confirms how far along the pregnancy is and how many babies there are, and is often combined with a blood test to screen for Down’s syndrome and some other chromosomal conditions.
- Anomaly scan, at around 18 to 21 weeks: a detailed look at how the baby is forming and where the placenta lies.
- Glucose test for gestational diabetes, commonly between about 24 and 28 weeks.
- A repeat blood count at around 28 weeks, and anti-D for women who are rhesus negative.
- Growth scans later on when there is a reason, such as a bump measuring smaller or larger than expected, or twins.
Diagram
Antenatal care across 40 weeks
The baby grows through each stage
- Initial visit ideally before about 10
- Dating scan around 11–14
- Baby’s movements begin to be felt about 16–24
- Anomaly scan around 18–21
- Glucose test for gestational diabetes commonly 24–28
- Bump measured and plotted from about 24
- Checks every two or three weeks, then closer from around 28
- Estimated due date about 40
- Scan
- Check or test
- What you notice
Looking after yourself while you are pregnant
Folic acid is advised before conception and up to about 12 weeks, because it lowers the chance of spina bifida. Vitamin D is advised throughout pregnancy and breastfeeding; even in a sunny climate, time indoors and covered skin limit how much the body makes. Iron and other supplements depend on your blood tests and history.
Some infections carried in food, such as listeria and toxoplasma, can affect a pregnancy. Choose pasteurised dairy, avoid pâté and soft or blue cheeses unless cooked until steaming, and cook meat and eggs thoroughly. Avoid liver and vitamin A supplements, limit shark and swordfish, and keep caffeine moderate. No amount of alcohol is known to be harmless, and smoking, including shisha, affects the baby’s growth.
Moderate activity such as walking or swimming suits most pregnancies; avoid contact sports and anything with a risk of falling. From about 28 weeks, go to sleep on your side rather than your back.
Check with a doctor or pharmacist before taking any medicine, including over-the-counter painkillers and herbal remedies. If you take regular medicine for a long-term condition, ask before stopping it, because stopping suddenly can cause problems of its own.
Your own health in the weeks after birth
After the birth, your own recovery needs attention too. A postnatal check at about 6 to 8 weeks looks at your physical and emotional health, after earlier contacts in the days after birth.
Bleeding after birth (lochia) is heaviest at the start and becomes lighter and paler over the following weeks. A tear, stitches or a cesarean wound is checked at postnatal contacts; pain that worsens, redness, swelling or discharge can be signs of infection.
Pelvic floor exercises, started gently once you feel able, help bladder control. Leaking urine is common soon after birth, but ongoing leaking or difficulty controlling wind or bowels is worth mentioning because it can be treated.
Feeding takes time to settle, and help with the baby’s position and attachment often makes breastfeeding more comfortable. A painful red area on the breast with a fever can be mastitis and needs checking. Broken sleep is expected with a newborn; rest when you can and accept help at home.
Pregnancy is possible again before your periods return, even while breastfeeding, so contraception is worth discussing in the weeks after birth.
Tearfulness and low mood in the days after birth, the baby blues, usually pass within about two weeks. Low mood, anxiety or panic that lasts longer, or stops you coping, may be postnatal depression or anxiety; both are common and can be treated.
What to bring to your pregnancy check-ups
Having your information together makes each check more useful, especially if you have had care elsewhere:
- reports and scans from this pregnancy and earlier ones
- notes from previous births, including any cesarean operation note
- your blood group and recent blood test reports
- a list of all the medicines and supplements you take
- your questions, written down
When to seek urgent help
Call 998 for an ambulance or go to the nearest emergency department if you notice any of these, in pregnancy or after birth:
- Heavy vaginal bleeding, or passing large clots
- A severe headache, blurred vision or flashing lights, especially with swelling of the face or hands
- A gush or a steady trickle of fluid from the vagina
- Your baby moving less, stopping moving, or moving differently from usual
- Fever or shivering, or suddenly feeling seriously unwell
- Chest pain or sudden breathlessness, or pain and swelling in one leg
- Thoughts of harming yourself or your baby
Questions patients ask
When should antenatal care start?
NICE advises having the initial antenatal visit by about 10 weeks, so that early screening tests can be done in time. If you have a long-term condition such as diabetes, epilepsy or high blood pressure, or a previous pregnancy had complications, it helps to start earlier, and ideally to seek medical advice before conceiving.
How many scans are there in a pregnancy?
Most pregnancies have a dating scan at around 11 to 14 weeks and an anomaly scan at around 18 to 21 weeks. Further scans are added when there is a question to answer, such as concern about the baby’s growth, twins, or the position of the placenta.
Do I need to count my baby’s kicks every day?
A formal kick count is not recommended. What matters is knowing your baby’s usual pattern of movements, and seeking care the same day if it slows, stops or changes. Babies do not move less towards the end of pregnancy, despite what is sometimes said; movements continue into labour.
What happens at the 6 to 8 week postnatal check?
The check covers your physical recovery: bleeding, healing of any tear or cesarean wound, your bladder and bowels, and your blood pressure if it was raised. It also covers your mood, feeding and contraception. It is a good moment to mention anything that does not feel right, even if it seems minor.
Is it normal to feel low after having a baby?
Feeling tearful or up and down in the days after birth is common and usually passes within about two weeks. If low mood, anxiety or a sense of not coping lasts longer or gets worse, it may be postnatal depression or anxiety, and both can be treated. Because women often do not bring it up themselves, it is asked about at postnatal checks.