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Pregnancy

First contacts with services

After discovering they were pregnant, most women wanted to get in touch with their GP or midwife quite quickly, and some went almost at once. Although home pregnancy tests are now very accurate, several people wanted official confirmation. Some were offered another pregnancy test, but several were surprised their GP thought another test was unnecessary. The GP can also help estimate your due date, as the system for working out the length of pregnancy from the day of your last period can be confusing.

 

She was surprised the GP did not do another pregnancy test and told her to come back at 10 weeks.

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Age at interview: 33
Sex: Female
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We went to the GP. I went to the GP. I was quite surprised that they're not really very interested when you tell them you're pregnant. They believe you. They believe the Boots and Sainsbury's tests that you do, and you just sort of walk down the street and buy a load more to convince yourself.

I mean, what more would you have liked in those first few weeks?

He was very nice. You know, he said, "Congratulations, but until you're actually, until you're ten weeks pregnant, we don't really need to know.' I suppose once they've said it all it makes sense, because there are people have miscarriages and whatever, and until you've had a baby you have no reason to be in contact with that, so you don't know the protocol. So I don't think I would have wanted more. I mean he was perfectly pleasant, in the, you know, 'Well done. I hope it was planned' you know, he checked that, which was quite ironic. But I suppose they're not all planned.

 

She went to the GP thinking she was 8 weeks pregnant and discovered she had not understood how to...

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Age at interview: 32
Sex: Female
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And at what point did you make contact with health care about the pregnancy?

It was about 8 weeks. Again I, I didn't see the point of rushing down to the GP's just to have something confirmed that I already knew. And I wasn't particularly aware of the fact, the need to get into the system, as it were. So it was, I think it was about 2 months in.

What prompted you to go at that point?

I think, I had a general awareness, because I've got three, I've got three sisters and they've all had children and I had a general awareness that there were scans available and that the 3 month sort of timescale was, was significant in some way, and so I thought, 'Well, if I go a month before that I can find out, you know, what's on offer and, and start to sort of get my head round what's, what, what the services are' really.

Did you know about things like folic acid and stuff before?

I did know about folic acid, yes. Yes. I think it was from general awareness, but also in terms of probably talking to other people around, around pregnancy and pre-conception.

Right, so you'd been taking it beforehand?

I'd been taking it beforehand, yes.

OK. And so who, you saw the GP when you went?

Mm, yeah.

And what was the response?

That was an interesting conversation, because I, [laugh] I thought I'd worked out when my due date was, and so sort of merrily pranced in to see the GP and was just expecting him to confirm it and give me sort of information about next steps. And the date he gave me was 3 weeks before what I expected him to say and it made me realise that I didn't actually understand how pregnancy is calculated [laugh]. And all this business about 40 weeks from the date of your last period. You know, I, I'd looked it up in, in a book and, and I couldn't quite work out the fact that it's calculated from a certain date at which point you're not pregnant at all. It didn't make sense to me and, and so I had to sort of do a bit of readjusting in my mind that it wasn't going to be sort of S-, into Septem, middle of September, it was probably going to be the end of August [laugh].

A few people chose to wait until 10-12 weeks before making contact, thinking that little could be done in the first few weeks anyway. (With hindsight this mother felt more advice and reassurance earlier in pregnancy would have helped).

 

She did not rush to make an appointment with her GP. With hindsight more information would have...

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Age at interview: 30
Sex: Female
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So this time around you found out at 6 weeks. What stage did you go to a doctor or midwife?

I didn't go until I was about 10 weeks, because... I get the impression they don't really sort of do anything before then anyway. They just tell you to go home and wait. So I thought there's no point going to the doctor's like straight away. I might as well wait until before they're going to do something [laughs]. So I just waited till 10 weeks to go.

And what happened when you got there?

I had, the midwife came round. The midwife came round and gave the interview, and then I was sent for a scan, for the 12 week scan shortly afterwards.

Was that just a dating scan or was it a -

The dating scan.

nuchal fold the, where they look whether the baby's got Down's syndrome?

No, it was just the, it was a dating scan.

Were there times in that first twelve weeks when actually you wished there was some more support or information or anything?

I think a little bit you do, because I think even if you just have something to read, like the pregnancy book or something like that, I think that might be quite helpful, especially if you go, I mean at, if you go quite early, if you've never had a child before and you're sort of decided you want to keep it, and say you find out at six or seven weeks, I suppose it can be good to know there's, what to do, maybe not to eat this, not to eat that. So that kind of thing is quite useful, I think, and knowing that the doctors are, are, to feel that they might be doing something about it or putting you on a list or something like that. I think that can make you feel like there's something happening. Because obviously things are happening for you, in your body and obviously in your life, but obviously, you know, no-one's there to - you get no reassurance from the medical people or anything like that. So I can see how it would be useful to have some, some information or contact with someone in those early weeks.

NICE guidance (National Institute for Health and Clinical Excellence - Antenatal care CG62) suggests women should have at least one antenatal visit before 10 weeks. Many valued early advice on general health topics such as diet and exercise (see 'Advice on health and lifestyle'), and being given the NHS booklets for pregnant women such as The Pregnancy Book. (See also 'Finding information and support'.)

In addition, it may help to get early information about antenatal screening. The nuchal translucency scan used as part of the combined screening for Down’s syndrome and other chromosomal abnormalities is most effective if done before 14 weeks (it is normally done as part of the dating scan 11 to 14 weeks), women need to know about this option early enough and not delay the dating scan past 14 weeks if they want one, so it is important to see the GP or midwife early enough to discuss whether to have one and to book the appointment. (See the Healthtalk website on 'Antenatal screening' for more information). Miscommunication between their GP and midwife delayed one couple's booking-in appointment, affecting their choices about screening.

 
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A mix-up in arranging her booking visit meant they had little time to discuss screening choices.

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Age at interview: 33
Sex: Male
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Mother' I think I was about 7 or 8 weeks pregnant. No, probably before then a little bit, actually, probably around 6 weeks pregnant, I think, something like that, 5 to 6 weeks. And I had, I said, 'I'm pregnant', and I wanted to just ask about what the process was, because I wasn't sure what, what do you do now? And she sort of said, 'Oh, yes, well, I'll fill this form in and you sign it. And we send this off and the midwife will contact you. It's all done for you. You don't, you don't have to worry.' And I had asked at that time about antihistamines, 'What is the, you know, the process on antihistamines?' I know that obviously when you're pregnant there is, you have to be careful, but if I need to take any anti-, antihistamines, and she said, 'Oh, no, I advise against antihistamines totally.' And that was it really, and that was my appointment.

Father' But it was more a, from the way it was described to me, it was a case, it was like going in and saying, 'I think I'm pregnant' and they went, 'Yep, okay. Well done. Go away.'

Mother' Yes.

Father' And they even failed to send the form off, didn't they?

Mother' Yes, well --

Father' Because the midwife never got in touch with us.

Mother' No, I did wait.

Father' So that was quite---

Mother' And I was almost sort of like, 'Oh, when am I going to get to that stage when I'm 10 weeks and they're going to contact me for my appointment?' And I waited and waited and waited, and I just thought, 'Well, I don't want to be sort of harassing people to say, 'Why haven't you contacted me?'' So I did, I just thought, 'I'll wait for them, because they said they would contact me'. And I never expected them just to forget about it, which was apparently what had happened, and somehow this form had got mislaid and hadn't reached the right person or it wasn't written up in the book. 

And so eventually when I got to, I think I was between 12 and 13 weeks when, by the time I got to see the midwife. But I'd just, I'd rung the week before and said, 'I'm really sorry to bother you but, you know, I'm expecting a call from, from you or from a midwife to arrange a booking-in appointment, and I just wondered when that was going to happen.' And the, the midwife contacted me to say that, 'Oh, I'm really sorry, we just totally haven't got your details, because whichever procedure has broken down, we don't know. I do apologize.' Anyway, and, and when we actually went in for the booking, booking-in appointment, to fill out all the forms, this midwife was falling over herself to apologize, because one thing that came up in the booking-in appointment was that the nuchal fold scan that you have for Down's syndrome was done at 13 weeks, and of course I was almost there. And so we literally didn't have any time to think about, 'Well, do we want to do this? Do we not want to do this?' And in the end it got to the stage where I thought, 'Well, no, I think we'll just leave that for now.' And I think because of that breakdown in communication, wherever it happened, you know, I just felt some choices had been taken away from me, really. I didn't have enough time to think about things, which would have been a very good thing to do, because I think those things are import

Several people were surprised when they first went to their GP that they were not greeted with more celebration or congratulations, and that they were told there would be no further appointments for a few weeks. One mother would have liked more contact in the first few weeks, more for reassurance than for any medical reason. This is especially true in a first pregnancy, when people have no experience to help them know what to expect.

 

She expected more reaction from the midwife to the news she was pregnant. More informal contact...

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Age at interview: 33
Sex: Female
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What was the care like in the first trimester of pregnancy?

Both times it's been quite sort of hands off. I think that the first time you're pregnant you go to the midwife expecting fireworks and, and people to say 'Oh that's absolutely fantastic' and of course to the healthcare professional it's just another person, we're just another appointment that morning. And I felt it was quite low key whereas perhaps I think I would have preferred a bit more, I perhaps would have preferred more appointments at the beginning and fewer in the middle. Because it would- you go in and you say you're pregnant and they say, 'Well, come back in twelve weeks' which seems like a huge amount of time.

So yes, I was quite surprised at how, how sort of non-interventionist they were at the beginning. But then having said that I wouldn't want, I mean it's an interesting balance, because you wouldn't want them to be too medicalised, I mean I just said that I want it to be all natural so, it's interesting the sort of balance. I suppose it would be nice to have people to go to, maybe just to go and talk to rather than actually having anything going on. You wouldn't necessarily need to have any tests or procedures, but it would be nice maybe to go and see the midwife every month just for a ten minute chat. That would have been reassuring.

What would you have wanted to discuss with her for those ten minutes?

I'm not sure, maybe things like, things like diet, things like how you're feeling physically, any sort of morning sickness, those sorts of things. Things that you can do to help that like ginger, or some natural things and just have a bit of a chat with someone who knew what they're talking about and who could say "everything seems to be going fine". 

With the second pregnancy are you still, did you still find that you would have liked more contact within the first trimester?

Possibly, I certainly wouldn't have minded having more contact. I don't feel I needed it so much, but certainly if I'd had the opportunity to have appointments I certainly would have gone. So yeah, I think I would have probably, on balance, I would have liked to have more.

Part of the reason for a low-key response from professionals is the risk of miscarriage in the early weeks. GPs and midwives must try to make sure people have realistic information about the chances of miscarriage without scaring them and spoiling their joy. A few people were distressed by being told very abruptly about the risk of miscarriage.

 
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The first GP they saw explained the risk of early miscarriage very bluntly.

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Age at interview: 33
Sex: Female
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The first appointment that we had with the doctor wasn't actually my own GP. It was obviously my GP practice, but it wasn't my GP and she was, negative's maybe going a little bit too far, but her exact words to us were, because my husband came with me, 'Of course this is very, very early on in your pregnancy and there's no guarantee that you will actually go to full term.' And I mean I was quite horrified. I just thought, 'I really can't believe you've just said that.' My husband was really quite upset by it, and really, you know, 'We shouldn't tell anybody and the risk must be huge,' and I said, 'Well, no, it's not. I mean, it's something like, what, 25% or something?' I said, 'But, you know, I'm really quite horrified that she said that.' But she said, 'But not of course that I'm suggesting that will happen but, you know, you are aware of that.' And I did actually mention it to my own GP when I went back the following week and said, you know, 'If that is what she's saying to other people, then that could really, really upset people.'

What was your own GP's reaction?

Well, she was quite horrified, so I'm sure that the individual will have been spoken to about it.

Another difficult issue for doctors and midwives is checking sensitively whether the mother is happy to be pregnant. Two young single mothers with unplanned pregnancies explained their contrasting experiences' one felt unable to tell her GP that she was considering a termination, while the other was offended that the midwife who booked her in assumed she might not want to keep the baby, and this spoilt their relationship.

 
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Her GP assumed she was happy to be pregnant, so it was difficult to discuss her anxieties.

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Age at interview: 24
Sex: Female
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I got, because I also went to the family planning clinic as well. I found them a little bit more helpful. And I got leaflets about eating certain foods and bringing up a baby. And then when I did go back to the doctor she put me for the first scan, like I said. And then she was telling me what foods to avoid and what foods not to avoid, and she checked my health, my urine and everything was all right, and asked me how I'm doing at work, and that was about it really. She didn't ask me anything else. I didn't talk to her at all about abortion or anything like that. So maybe that was my, maybe that was my error. I think when, because when I first told my doctor I was pregnant she was under the impression that I was going to have it anyway, and I didn't tell her any different [laugh]. So maybe if I'd told her that I wasn't too sure, then things might have been different.

So it was the family planning clinic where you had the discussions about abortion?

Yeah, yeah. I talked to them more about abortion.
 
 

She was upset that the midwife at the booking visit assumed she might want a termination because...

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Age at interview: 23
Sex: Female
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That, it was difficult because I was single, there was an automatic assumption that I, there was a decision to make on whether I keep the baby or not, which to me, there wasn't, there wasn't really. At least I hadn't told anybody else there was. When the midwife came round to, for my first booking in my home, she actually commented on, 'Am I wasting my time being here? Are you going to actually keep this baby?' Which I found really, really difficult because I'd made no, no reference to having a termination or anything like that. I had, I had no intentions of it. So her attitude, presumably because I was single, because I'm young, was that, 'Am I going to get rid of it?' Which I found really difficult, actually, and it spoiled the relationship between me and my midwife for the rest of the pregnancy.

Did you ever say anything to her about that?

No, no, I'm not the type of person to, I just, I let that go, I didn't say anything about that.

But you say it made the relationship with your midwife difficult for the rest of the pregnancy?

Yeah, yeah, it made, it made it difficult because she's obviously, to, to me that means she's got a view in her mind of who I am and the type of person I am and so I found it difficult to relax with her and be comfortable with her and be myself with her.

Some people's first contact with health services happened not by choice but as an emergency, for example as a result of bleeding in early pregnancy. Women who had experienced this were generally positive about the care they had received at such an anxious time, especially from Early Pregnancy Units (see 'Bleeding and miscarriage'). People who had a previous history of miscarriage or other problems such as a genetic abnormality were usually seen earlier and more often in their next pregnancies, and found this helpful. One couple had previously had a termination because the baby had a genetic abnormality. When they went to tell the GP about their next pregnancy, they were pleased that he understood they would be feeling anxious and sad.

People were also seen earlier than usual if they had had fertility treatment, or had another condition such as diabetes or epilepsy which might affect the pregnancy. In these cases pregnancy was closely monitored from the start, often in a specialist hospital unit. (See 'Pregnancy with another condition or disability').

See also 'Finding information and support' and 'Maternity care and antenatal visits'.

Last reviewed May 2017.
Last updated
May 2017.

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