Your main provider of antenatal care as well as postnatal care will be your midwife. Read on to learn more about midwifery, the pregnancy care you can receive, midwife appointments and the differences between using a community midwife and the experience of shared care.
This article covers:
Arranging antenatal care with a midwife
Pregnancy care: first midwife appointment
Antenatal care and midwife appointments
Your midwife care during labour
Your care after the birth: postnatal care
How can I get continuity of care?
You will see a midwife regularly both during your pregnancy (antenatal care) and afterwards (postnatal care). To find a community midwife you may need to contact your GP surgery, but there is no need to see a doctor unless you have a medical problem.
Once you have contacted your midwife she will arrange your midwife appointments. Your first visit will be at around eight to ten weeks of pregnancy. This is known as your ‘pregnancy welcome visit’ or, more often, your ‘booking appointment’.
Another option is to arrange to have ‘shared care’ with your GP and the hospital. This means the majority of your appointments will be at your GP’s surgery. While this can be very convenient, your GP will not attend the birth and it means you are unlikely to know the midwives at the hospital when you go in to give birth.
You also have the option of choosing an independent midwife, who is a fully qualified midwife who has decided to work outside the NHS in a self-employed capacity to provide pregnancy care.
At the booking appointment your midwife will spend quite a long time finding out all about you and your pregnancy. She will ask you questions about your medical history, any previous pregnancies and also about your current pregnancy. If she is a midwife you will be seeing regularly this is an opportunity for you to get to know each other and for her to find out about your hopes for the pregnancy and when your child is born. She will answer all your questions and should also be able to help you with any concerns. She will let you know how to contact her, if you need to.
Your midwife can also advise on diet, exercise, and dealing with minor discomforts of pregnancy. She will outline what your options are for antenatal tests and screening and explain the purpose of each test. You will be provided with information about the various tests which you can take away and consider, so that you and your partner can decide whether you wish to have any of them.
At every antenatal appointment your midwife will, with your consent, routinely take your blood pressure, test your urine for glucose and protein, and feel your abdomen to see how your baby is growing. She will write everything down in your maternity notes. You’ll be given a copy of your own maternity notes to look at, keep, and to bring to appointments.
When the baby has grown enough, your midwife may listen to the baby’s heart rate with a hand-held device that uses ultrasound waves (if you are happy to have ultrasound). Later in pregnancy the baby’s heart rate may be heard using a Pinard stethoscope. Once your baby is big enough for you to feel movements, your midwife will ask if the baby is active. Toward the end of pregnancy it will become more important for your midwife to establish which way the baby is lying in your uterus. At certain points further blood tests will be done with your consent. These checks form the basis of every antenatal appointment a woman will have and they become more frequent as pregnancy progresses.
If you have booked a home birth, your midwife will come to assess you at home when you go into labour. If you are having a hospital birth, some community midwives do home assessments before you go into hospital, but often you will have to make your own way to hospital at some point during your labour, before you are seen by a midwife.
During labour, your midwife’s job is to support and help you. She is also there to support any birth partners you have. Her role includes helping you to give birth in the way that you would like, and to monitor your health and that of your baby. She can help you to get into positions that are comfortable and will help labour progress, and she can suggest ways of coping with contractions. If your midwife feels concerned at any point that things are not progressing normally, she will liaise with medical staff.
If you are being looked after by a team of community midwives, you may already know the midwife who is with you during labour. If your labour is long, you may experience a change of shifts; your midwife will go off duty and be replaced by one who is just starting her shift.
In the days and weeks following the child being born, you will be visited at home by a midwife who will examine you and your baby to make sure that you are both adjusting well. In some areas, the midwife may stop visiting once your baby is ten days old, but in other areas she may carry on visiting for up to 28 days after the birth. She will ensure that your baby is feeding well and beginning to gain weight, and that you are recovering well from the birth.
Research shows that to receive care from the same person throughout pregnancy, labour and the postnatal period provides a better birth experience for a woman than if she is looked after by lots of different people. One way of getting continuity is to book a home birth. Some women book one even if they are not sure that it's what they want, and they make their final decision later on during their pregnancy or even in labour. You are also more likely to receive continuity of care if your delivery occurs at a birth centre.
If you are planning to give birth in a hospital unit, or if you opt for shared care, it’s not always as easy to get to know your midwives.
Some hospitals operate a team-midwifery system, usually run by community midwives. If you have only one local hospital, you can ask whether it is possible to have midwifery-led care, and to be looked after by a small team of midwives. If you have several maternity units to choose from in your area, you may need to ask several of them. Some hospitals have teams that operate only in certain areas, which may limit your choice. If you are in doubt, phone up your local community midwives and discuss it with them.
NCT's helpline offers practical and emotional support in all areas of pregnancy, birth and early parenthood: 0300 330 0700. We also offer antenatal courses which are a great way to find out more about having a baby, labour and life with a new child.
The Nursing and Midwifery Council website gives more information about the role of the midwife as well as a leaflet called Raising concerns about a nurse or midwife, which explains how patients, carers and the public can raise a concern about a nurse or midwife.
You can also get an insight into what midwives do at the Royal College of Midwives website.
NHS Choices provides a list of questions to ask your midwife or GP.