Women and their husbands/partners have the right to be involved in all decisions regarding their

antenatal care. They need to be able to make informed decisions concerning where they will be
seen, who will undertake their care, which screening tests to have and where they plan to give
birth.

Women should be advised of the benefits of eating a balanced diet such as plenty of fruit and
vegetables, starchy foods such as pasta, bread, rice and potatoes, protein, fibre and dairy foods.
They should be informed of foods that could put their fetus at risk.

Organization of antenatal care

Antenatal care has been traditionally provided by a combination of general practitioners,
community midwives
and hospital midwives and obstetricians. The balance has depended on the perceived normality of
the pregnancy at booking. However, pregnancy and childbirth is to a certain extent an
unpredictable process. The frequency of antenatal visits and appropriate carer must be planned
carefully allowing the opportunity for early detection of problems without becoming over-
intrusive.
A meta-analysis comparing pregnancy outcome in two groups of low-risk women, one with
community-led antenatal care (midwife and general practitioner) and the other with hospital-led
care did not show any differences in terms of preterm birth.

Frequency and timing of antenatal visits

The first appointment needs to be early in pregnancy, certainly before 12 weeks if possible. This
initial appointment should be regarded as an opportunity for imparting general information about
the pregnancy such as diet, smoking, folic acid supplementation etc. A crucial aim is to identify
those women who will require additional carein the pregnancy.
The next appointment needs to be around 16 weeks gestation to discuss the results of the screening
tests. In
addition, information about antenatal classes should be given and a plan of action madefor
thetiming and frequency of future antenatal visits including who should see the woman. As with
each antenatal visit, the blood pressure should be measured and the urine tested for protein. The
20-week anomaly scan should also be discussed and arranged and women should understand its
limitations.
At each visit the symphysio-fundal height is plotted, the blood pressure measured and the urine
tested for protein. At 28 weeks’ gestation, blood should be taken for haemoglobin estimation and
atypical red-cell antibodies. Anti-D prophylaxis should be offered to women who are rhesus
negative.Afollow-up appointment at 32 weeks will allow the opportunity to discuss these results.
A second dose of anti-D should be offered at 34 weeks. At 36 weeks, the position of the baby
needs to be checked and if there is uncertainty, an ultrasound scan arranged to exclude breech
presentation. If a breech is confirmed, external cephalic version should be considered. If placenta
praevia had been noted at 20 weeks a follow-up scan at 36 weeks is needed. For women who have
not given birth by 41 weeks, both a membrane sweep and induction of labour should be discussed
and offered.