When your pregnancy is confirmed you will need to prepare for parenthood and ensuring that you remain physically and emotionally well throughout pregnancy is of the utmost importance. Antenatal care is part of this preparation and your first visit to your doctor or midwife after your pregnancy has been confirmed is an important occasion.
What to expect

At this visit you will have an opportunity to meet some of the people who will be involved in your care during pregnancy. Your doctor or midwife will gain an overall view of your general health and pregnancy and will give you advice on what to expect in the months to come.

You will have a thorough physical check-up including detailed exploration of your medical history, your partner’s medical history and that of your families. This will provide an opportunity for your doctor or midwife to discover any obvious or potential health problems as well as ensuring that you are perfectly well. You will be given nutritional advice, genetic counselling (if appropriate), general information and reassurance that all is well. At this visit you may also wish to discuss the sort of birth you would like and your preferences as to the environment in which you want to give birth.

Investigations

The following are some of the topics usually investigated during the first antenatal check-up:

Age
If you are very young you may need extra help in preparing for motherhood. In women over the age of 35 there is a slightly increased risk of genetic abnormality so they may be offered other specialised blood tests or amniocentesis (a common test in which a small sample of the amniotic fluid surrounding the foetus is removed and examined).

Lifestyle
If you smoke, drink alcohol, take any regular medication or use recreational drugs you need to tell your obstetrician or midwife as these may have an effect on your pregnancy.

Reproductive and genital organs
A full menstrual history will be taken in order to estimate your expected due date. An internal examination may be done to check your uterus and ovaries but this is not routine. A cervical smear may also be taken but again is not done routinely. Your urine will also be tested.

Previous obstetric history
A detailed obstetric history is vitally important in every pregnancy. This should include details of previous miscarriages or abortions, any problems with fertility and any previous problems you may have had during pregnancy, labour and childbirth. If you are unsure or can't remember details ask your doctor or midwife to access your previous obstetric chart.

Social and family history
The age, education and marital status of both partners as well as your attitudes towards pregnancy and childbirth will be discussed. Your hopes and fears, as well as your own experiences during infancy and childhood, are all important as you prepare for parenthood. In addition, it is important to find out if there is a history of multiple births, diabetes, high blood pressure, heart disease or congenital abnormality in either of your families.

Diabetes
If there is a family history of diabetes or your urine contains sugar you may be offered a glucose tolerance test to exclude diabetes. If you suffer from diabetes you may be referred for specialist care to an endocrinologist.

Blood pressure
Your blood pressure will be recorded in order to obtain a baseline reading. If you have a history of high blood pressure you may be referred for specialist care.

Digestive tract
You will be asked if you are experiencing nausea, vomiting or constipation as these can all occur during pregnancy. Specific nutritional advice will be discussed if any of these are a problem.

Respiratory system
If you suffer from chronic respiratory congestion, asthma or bronchitis you may need special attention. Avoiding smoking, eating healthily and taking regular exercise are helpful.

Spine and pelvis
Back pain is a common problem in pregnancy, usually due to postural imbalance of the spine. During pregnancy the ligaments that surround all the joints in the body become soft, the shape of the spinal column alters and the pelvic joints expand. Any underlying imbalance in the mechanics of the spine will be affected during pregnancy. If you suffer from back pain you may be referred for physiotherapy.

Past illnesses or operations
It is important to assess if these will have any bearing on your pregnancy or labour.

Congenital abnormalities
These are rare however women over the age of 35 and couples with family histories of genetic defects need special genetic counselling about the risk of abnormalities. Vitamin and mineral supplements before conception may reduce the incidence of conditions such as spina bifida.

It is vitally important to avoid having x-rays if you are trying to conceive and when you are pregnant. If you require dental x-rays these are generally safe as long as you are adequately protected.

Nutrition
One of the most important functions of antenatal care is careful attention to your diet and eating habits. Your nutrition during infancy and childhood may also have some bearing on your pregnancy. You will be weighed in order to get a baseline weight.

Your emotional state
Your emotional state is as important as your physical state during pregnancy. If you have emotional or psychological difficulties such as depression or anxiety, or if you are having problems with relationships, you may benefit from counselling or psychotherapy during and/or after pregnancy. Voicing any fears you may have about pregnancy and parenthood can help to resolve them, and in this way it may be possible to prevent the onset of postnatal depression.

Blood tests

Haemoglobin
Haemoglobin is a substance in red blood cells that combines with and carries oxygen around the body, and gives blood its red colour. Reduced levels of haemoglobin in the blood indicate that you might have anaemia. Your blood will be taken to check your haemoglobin level at your first antenatal visit and again usually during the last 10 weeks. If your haemoglobin is low you may be advised to take iron supplements or to improve your dietary intake of iron.

Blood group and Rhesus factor
Your blood group will be checked so that in the unlikely event of an emergency you can have a blood transfusion. 85% of people are Rhesus positive (Rh+), which means that their blood contains the Rhesus factor, a protein attached to the surface of red blood cells. If you are Rhesus negative (Rh-) and lack the Rhesus factor and your baby's father is Rh+ this can, in rare circumstances, lead to a complication in your baby called Rhesus disease. Fortunately Rhesus disease is now almost entirely preventable.

Rubella (German measles)
A blood test will be performed to check if you have had this infection. Since the symptoms of rubella are often mild only a blood test will tell if you have had it or been vaccinated against it in the past. Rubella, especially if contracted in early pregnancy, can cause complications for your baby.

Syphilis
A blood test for syphilis is also performed, as the disease needs to be treated with antibiotics.

Follow-up antenatal visits

During the first 28 weeks of pregnancy you will probably be advised to visit the antenatal clinic once a month. After 28 weeks the frequency of your visits will increase until the last month, when you will be asked to attend the antenatal clinic on a weekly basis.

At each antenatal clinic you will have your urine checked. As well as being tested for protein, which may be due to a urinary infection or occasionally (if it is associated with high blood pressure) pre-eclampsia, it is also tested for glucose, which may indicate diabetes. Your blood pressure is recorded, as high blood pressure (hypertension) can be a complication of pregnancy. You will also be checked for any oedema (fluid retention), which may indicate pre-eclampsia if combined with high blood pressure and/or protein in the urine.

Routine weighing is not usually done. Your midwife or doctor will palpate your abdomen to check your baby's position, how he/she is growing, the amount of amniotic fluid surrounding your baby, the size of your uterus and, towards the end of your pregnancy, whether the head has engaged (entered into the pelvis). Your baby's heartbeat will be checked and recorded.