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Making the most of antenatal care

Having regular antenatal care is important for your health and the health of your baby. However, sometimes antenatal visits can seem quite an effort. If the clinic is busy or short-staffed you may have to wait a long time and, if you have small children with you, this can be very exhausting. By increasing the number of women that are cared for by their GP and community midwife, antenatal care should become more convenient.

 

Try to plan ahead to make your visits easier and come prepared to wait. Here are some suggestions.

  • In some clinics you can buy refreshments. If not, take a snack with you if you are likely to get hungry.
  • Write a list of any questions you want to ask and take it with you to remind you. Make sure you get answers to your questions or the opportunity to discuss any worries. Sometimes this can take quite a lot of determination. 

  •  If your partner is free he may be able to go with you. He’ll be able to support you in discussing any worries or in finding out what you want to know. It will also help him to feel more involved in your pregnancy.

  • If you regularly wait for long periods at your clinic, bring this to the attention of the hospital management. They have a responsibility to ensure that Patient’s Charter standards are met.

  • "There were some things that really annoyed me – the gowns, and the lavatories, and one midwife who called everyone “sweetie”. But there were other things I wouldn’t have missed – like hearing my baby’s heart beating, and well, just knowing she was all right.Knowing I was alright too, come to that.

 

  • ‘I think it’s up to you to make the most of it. You can find out a lot, but you have to ask. When your blood pressure’s take, you have to say, “Is that all right?”. Then they’ll tell you. And if it’s not all right, you have to ask why not, and talk about it. It’s the same for everything. It’s not being a nuisance, it’s being interested. I think the staff like it if you’re interested."

 

At your first antenatal visit, your doctor or midwife will enter your details in a record book and add to them at each visit. Many hospitals ask women to look after these notes themselves. Other hospitals keep the notes and give you a card which records your details. Take your notes or card with you wherever you go. Then, if you need medical attention while you are away from home, you will have the information that’s needed with you.

 

The page opposite gives a sample of the information your card or notes may contain, as each clinic has its own system. Always ask your doctor or midwife about anything on your card which you would like to have explained.

 

Relation to brim

At the end of pregnancy your baby’s head (or bottom, or feet if it is in the breech position) will start to move into your pelvis. Doctors and midwives ‘divide’ the baby’s head into ‘fifths’ and describe how far it has moved down into the pelvis by judging how many ‘fifths’ of the head they can feel above the brim (the bone at the front).

 

They may say that the head is ‘engaged’ – this is when 2/5 or less of the baby’s head can be ‘felt’ (palpated) above the brim. This may not happen until you are in labour. If all of the baby’s head can be felt above the brim, this is described as ‘free’ or 5/5.

 

Position

The above abbreviations are used to describe the way the baby is lying – facing sideways, for example, or frontwards or backwards. Ask your midwife to explain the way your baby is lying.

 

Blood pressure (BP)

This usually stays at about the same level throughout pregnancy. If it goes up a lot in the last half of pregnancy, it may be a sign of pre-eclampsia which can be dangerous for you and your baby.

 

Fetal heart

Fetal heart  ‘FHH’ or just ‘H’ means ‘foetal heart heard’. ‘FMF’ means ‘foetal movement felt’.

 

Oedema

This is another word for swelling, most often of the feet and hands. Usually it is nothing to worry about, but tell your doctor or midwife if it suddenly gets worse as this may be a sign of pre-eclampsia (see page 84). 

 

Hb

This stands for ‘haemoglobin’. It is tested in your blood sample to check you are not anaemic.

Date

This is the date of your antenatal visit.

 

Weeks

This refers to the length of your pregnancy in weeks from the date of your last menstrual period. 

 

Presentation

This refers to which way up the baby is. Up to about 30 weeks, the baby moves about a lot. Then it usually settles into its head downward position, ready to be born head first. This is recorded as ‘Vx’ (vertex) or ‘C’ or ‘ceph’ (cephalic). Both words mean the top of the head. If your baby stays with its bottom downwards, this is a breech (‘Br’) presentation. ‘PP’ means presenting part, that is the bit of the baby that is coming first. ‘Tr’ (transverse) means your baby is lying across your tummy.

 

Urine

These are the results of your urine tests for protein and sugar. ‘+’ or ‘Tr’ means a quantity (or trace) has been found. ‘Alb’ stands for ‘albumin’, a name for one of the proteins detected in urine. ‘Nil’ or a tick or ‘NAD’ all mean the same: nothing abnormal discovered. ‘Ketones’ may be found if you have not eaten recently or have been vomiting.

 

Height of fundus

By gently pressing on your abdomen, the doctor or midwife can feel your womb. Early in pregnancy the top of the womb, or ‘fundus’, can be felt low down, below your navel. Towards the end it is well up above your navel, just under your breasts. So the height of the fundus is a guide to how many weeks pregnant you are.

 

This column gives the length of your pregnancy, in weeks, estimated according to the position of the fundus. The figure should be roughly the same as the figure in the ‘weeks’ column. If there’s a big difference (say, more than two weeks), ask your doctor about it. Sometimes the height of the fundus may be measured with a tape measure and the result entered on your card in centimetres.

 

 Information provided by Health Promotion England.