Maternity care and antenatal visits
Patterns of antenatal care vary widely, depending on the area where a person lives, their own preferences and whether they have any special health needs. National Institute for Health and Clinical Excellence (NICE guidance CG62) suggests women should have at least one antenatal visit before 10 weeks and guidance on what to expect is available from their website.
Many people have most or all of their antenatal appointments in the community - in their local surgery or clinic, and sometimes at home. Care may be provided mainly by midwives or shared between midwives, GPs and obstetricians. Many people really valued the relationship with their local midwives and said how friendly, reassuring and supportive they were.
She valued regular appointments with her midwives and the reassurance and information they gave her.
Yeah, like I say, they, they were brilliant. They were really good, they gave me all the information that I needed and they you know, told, told you everything you needed to know and it's just nice to go in for your check-ups and know you were going in for your check-ups to, so they could tell you everything was in the right place and, you know, everything was going fine and there's nothing wrong with you. Because you can become quite paranoid about things being wrong and but no, they really put my mind at ease and they, they were very good.
Did you get paranoid occasionally?
Tell me what you got paranoid about?
Just, you just think, oh it's not moving today or, you know, there must be something wrong or just general, just generally that, actually, the, the movement thing, when they start moving at, what is it? 5 months or whatever, 4 or 5 months, that was when I started to become more paranoid because, you know, oh, he's not moving today, what's wrong? Blah, blah, blah, and I was waiting for my midwife appointments so I, you know, so they could confirm the heartbeat and, you know, everything was fine but no, they, they were good. And I think they should, shouldn't, because I heard that they were trying to stop, trying to not to have so many midwife appointments in, in the future. I don't know if that's still going on but I don't think they should do that, definitely not.
Especially in a first pregnancy, women wanted lots of contact with their midwives. Some people would have liked more contact between appointments but were worried about bothering midwives when they seemed so busy. One woman had problems getting even her regular appointments with the midwife because she was so over-booked. Other people were impressed that midwives gave them so much time. Some women with learning disabilities we talked to felt they were treated differently to other pregnant women and sometimes felt that their midwife did not listen to them or understand them (see Pregnancy and learning disability).
Especially in a first pregnancy women need a lot of advice and reassurance, but she did not want...
No, not, I mean, like I say, they need to, to definitely, to see their midwives as often as, as they can, really, I think that's, that's very important. And you know, probably more often than, than you do actually go in the, in the beginning. Because in the beginning you're only going every, once every 2 months to see, for your midwife check-up and I think you should be able to go when you like, really. That would be good.
How did you feel in between appointments?
I just felt that I wanted to go more often just to make, just to make sure everything's okay and I think especially with your first baby. I think when you've had a baby and you know, you've been through the experience and you know what's going to happen to you, you need, you know, you know what all these feelings and stuff that are going on. But yeah, like I say, especially with your first pregnancy, I think you need extra midwife attention. With the second one or third one or whatever, you're a bit of an old hat at it so I don't think you need it so much.
Were you able to ring up your midwife in between appointments?
You could do, yeah, yeah you could do.
Did you ever do that?
I didn't, no.
Because I just, I feel that all the people that work on, on the NHS, for the NHS, are very, very busy and I just, you know, nothing was wrong with me, nothing was wrong with me ever. So I didn't feel the, the urge to, to, to ring her and, you know, for no reason, so.
Were there ever times when there was just something that was bothering you and you would have quite liked to be able to speak to somebody? Or just be reassured?
Yeah, yeah, there was, there was times, like I say, if I'd had a couple of days of no movement or, you know, a day of no movement and you're supposed to have 10 movements a day and I'd only had 6 that day or something, [laughing] I'd think, ah. But it's just something that, you know, you, you are more paranoid about, about things and, like I say, especially with your first baby.
Her midwife was so busy it was difficult to book appointments in the last few weeks of pregnancy...
Well, in my doctor's surgery they have a midwife come round once a week, comes in and does the clinic there. On the whole it was fine. I mean, the only times was, there was quite a lot of women having babies around the same time as me, so when we got to the 32nd week and you're supposed to go in every week for a sc-, to be checked, that she was booked up with people to see. And that happened even like quite, quite close to the end, like even when I was 38 and 39 weeks. I think there was one of those weeks I didn't manage to get to see the doctor, see the midwife. And obviously I did feel a little bit anx- - well, not really anxious, but it's sort of like, that's definitely the sort of time I think you definitely need to go and see someone a lot, whereas in the earlier stages you can perhaps miss an appointment and, you know, feel relatively relaxed.
So that was the only thing for me, do you know what I mean? I felt maybe they hadn't prioritised well enough who they were going to see. Even though they were quite busy maybe they should put people who were at the end of pregnancy as a priority to be seen, rather than people who were just in the very middle of their pregnancy or something who can perhaps, do you know what I mean, miss an appointment or something like that. So that was the only thing if, if there wasn't enough, there wasn't enough health professionals in my, in my surgery to sort of - or they didn't have enough time to see all the women in the area, you know, which made you - I don't know. Yeah, I did feel a little bit [laughs] - how can I say? Yeah, it did make me feel a little bit - not neglected, but I did feel a little bit sort of like, “Oh, maybe she doesn't want, I'm not sure if she liked me very much. It sounds sort of a funny thing to say, but she was nice, she was a nice woman [laughs].
The care and attention from the midwives was brilliant, especially from one who did her booking...
And what was also brilliant about my antenatal care was, the woman who'd booked me in at the hospital, the midwife there, I told her how anxious I was and obviously with the start of my pregnancy being slightly uncertain. It was a Saturday afternoon I remember and she took about an hour just to sit and talk to me about it and things, tell me what to expect and just explain things, and she was absolutely brilliant. And then I didn't actually see her again until, I was overdue so I had to go back to the hospital. And she did my appointment there, because she was based in a different area because we'd moved and obviously everything, and she was at the hospital. And by this point I kind of had pelvic problems so I couldn't walk. And she was just great again, she was absolutely brilliant. So I had to be induced and they were sorting out a date for my induction and it was a choice between like ten days overdue or about sixteen days overdue. And she was like, 'I don't think you can wait that long'. So she basically got me in as soon as she could. And then what actually happened was, when I was in labour, which was overnight, she came on in the morning, and one of the nurses came in and said, 'There's somebody here who wants to deliver you'. And it was this woman. And she was fantastic, she was just great, so I love her to pieces, I think she's brilliant [laugh]. She just made it, she was so nice.
Many women thought midwives were friendlier and had more time to sit and listen than doctors, but some had a less happy relationship, particularly if they felt their midwife was being judgmental.
She felt the midwife was judging her ability to be a good mother and never felt comfortable with...
Well, it, it was difficult. After, after my midwife had done this assumption of having the termination and asked if I needed a social worker, you know, I'm a very competent, capable Mum, well I think I am, anyway [laughing]. And to, for her to be assuming like that, because I was on my own and young, made it difficult for her care of me the rest of the pregnancy because, like I say, I didn't feel comfortable. I didn't feel comfortable with her because I felt like she'd, she'd judged me and I wanted to be confident and happy in my pregnancy and, you know, it just, it just meant that I couldn't really open up to her. If I had difficulties, I feel if I was, I was finding, finding difficulties, I didn't want to go to her because I'd, you know, I didn't want to reinforce what she'd thought, that I was perhaps, discovered to be struggling because I was in my situation.
Was there anybody else that you could go to for advice and support?
I've got lots of friends and family that have been fantastic so in, in one respect, to be honest with you, second, second time round, this pregnancy, I wasn't too bothered, actually, by the whole health care thing because my family and friends were fantastic, so. And the, towards the end of the pregnancy I was taken, my care was taken over by a consultant because of the problems I had at the end of the pregnancy so I didn't see that much of her in the end so it was okay.
Jen felt she was treated like a disabled person by the midwife and couldn’t wait for her pregnancy to end.
Just not being treated like a disabled person because I just felt I was being treated like a disabled person, like, you know, because most women, they can go in and have a talk with the midwife and that but, even though the midwife was really nice and supportive, in a way, she didn’t really talk much to me about things. It’s like when like she checks to see if the baby is okay, she just goes, “Yep, the baby is fine.” And then that’s it. She didn’t like explain anything, so in a way, it’s put me off being pregnant again in in case, you know, just same same treatment.
Because I just didn’t enjoy it at all. I couldn’t wait for it to finish.
Her midwife had strong views on how women should give birth, which might make women feel guilty...
And so really what she was saying' 'And it will be your fault.' And at that point I got really quite angry and upset. Because I thought 1) if one looks at the evidence (and I went to talk to my GP about this), there is no evidence that actually doing these exercises makes any difference. But 2) there was a kind of value judgement wrapped up in there about how you should be giving birth. And because of my experience all I was thinking is, if my brother's problems [he was born with severe learning disabilities] were due to a problem with delivery, you know, all I was thinking is, 'I want a safe delivery. I don't care how I do it, I just want it to be safe.'
And this notion that there were kind of better forms of labour than others really kind of angered me. And, and what was interesting was when I finally sort of said to her that I felt this, that there were these kind of issues and that she was making women feel guilty, and the midwife just looked at me and said, 'I've never thought about that.' And I found that shocking, because I think there is this image that midwives are meant to be incredibly understanding and, you know, they're meant to be in touch with women and I didn't necessarily find that. You know, in many ways I found that she was dictating to me far more than the medical profession. Now in actual fact I had a pretty much natural labour which in the end I had to have an inst-, I had a ventouse. But I can tell you I was so relieved after 36 hours of labour for that to happen. But I found that, that was more, I think I found kind of interesting as a kind of dynamic.
What was the GP's reaction? I mean, did she say she'd speak to the midwife?
Well, she said, 'Well, you know, ask the midwife for her evidence on which it's based.' And she asked, I'd also, the midwife had given me a sheet of the type of things I should be doing , and so I gave a copy of that to the GP. And I kind of felt it was unfair to ask the midwife about, 'Show me all the research studies' because I just thought midwives don't do that. And that was why I decided to take this kind of other strategy of saying, 'Well, I'm not going to get into an argument about evidence. I want to get into a discussion about how you're making women feel,' because I thought that's something that she would be more receptive to. And as I said I was quite shocked when she came back with this sort of' 'I've never thought of that.'
An important factor was how far women felt empowered by their midwife to understand their care and make their own choices.
She had an excellent midwife who supported her in making informed choices about her own care.
She, but apart from her as a clinician, her as a person did make a big difference. She, she very much respected my need to express my own views about my pregnancy. The pregnancy went on beyond the due date and my little boy ended up being 11 days late and that, that was an example of, of her sort of collaboration with me I suppose in terms of how to proceed with my care, and it always felt that I was in control, which is very important to me. I suppose I was fairly well informed as a patient, as it were, and she said a couple of times to me, 'That's not the sort of thing most people ask me'. Or, she did say to me, 'You are very well informed', you know, and gave me that feedback.
One young mother found some midwives did not give her much information. She preferred one midwife who took time to explain things in a way she could understand. (See also 'Finding information and support').
She preferred one midwife who took time to explain things in a way she could understand. (Played...
So I went and asked my midwife, made an appointment and asked my midwife, and my midwife explained what everything was for me. And it was like, it was better for me really because it was the midwife that I used to get on with. She was really nice. She explained that, what to do and things like that and that. To wear my back brace. And she was always checking the baby to make sure the baby was in the right position. But other than that she was just fine, she was lovely.
Seeing the same midwife or small group of midwives every time was very important for some people, and one woman planning a home birth employed an independent midwife, partly to ensure she had continuity of care through to birth as well.
She chose to employ an independent midwife. Continuity of care and trust were important to her.
Okay, so you were, I take it then you were planning to interview a few and pick the one you liked the best?
Right, so what were your criteria, what, what did you want your midwife to be like?
Well, I placed a high priority when selecting a midwife on, an independent midwife, on the way that our personalities related to one another, because I think that giving birth is a highly personal experience, highly private experience and you need someone who is going to mesh with you in that, in that way. You need someone that you can trust. And that was definitely one of the factors in choosing to have an independent midwife as opposed to giving birth within the NHS, because I wanted that continuity of care, that was really important to me, that I would know the person who was going to help me give birth. Also she had to be experienced [laugh] and, and up to date in all her training obviously, I think that goes without saying.
One mother who is herself a GP had an excellent relationship with her community midwife, but had no continuity at her hospital antenatal appointments. She had not appreciated before how people are affected by what staff say and how they communicate. Others felt less strongly about continuity of care, and accepted that it was often not practical, even if they would have liked it. A few people who were not comfortable with their midwife would have preferred more variety.
Professionals do not always realise what an effect their words have on people. There was little...
So I think I've become much more aware of that. The other thing was I think I was surprised at how I felt about seeing a different doctor every time I went to the antenatal clinic and I hadn't really thought that that would be that important to me but in fact it was. And I saw somebody different every time I went which wasn't entirely satisfactory. This was at the antenatal clinic rather than the IVF clinic.
At the IVF clinic I, I suppose because I was there longer, spending longer there you build up a good relationship with one or two people and that was I think very important, really, because they supported you through that stressful time. And I know that the antenatal clinic is different because they're busy and they're only seeing you for a short time. But I think that I, I was surprised at how important it seemed to me to see the same person at the clinic when I went.
Did it- I mean how did it make you feel that you weren't able to see the same person every time?
I think I was slightly disappointed that I didn't see the same person every time. And also because I got slightly conflicting messages from two different doctors that I saw at one appointment and then one that I saw four weeks later. So I felt that maybe there wasn't much continuity- much communication within the team, which surprised me a bit. And it disappointed me a bit as well.
Did you point this out to them?
I pointed it out later on to the consultant because the fact that- on the same day that I had seen one doctor I saw the consultant later and I told her that two members of her team had given me different advice and, you know, she was very nice about it and said, you know, that maybe we wouldn't in retrospect have given you the advice last time that we gave you if we'd, you know, if we'd thought about it. So yes I did point it out to her and she took it on board I think.
Continuity of care is fine if you feel comfortable with your midwife, but she did not find her...
Midwife-led both times. First time, first pregnancy it was a midwife team. I can't remember the name of it. It's a midwife team and they basically are in the community and in the hospital, and they follow you within it, which is supposed to be quite good because it's consistent, maintains the personal contact, history etc, and that, I can really see the advantages. However, if you get a duff midwife they follow you everywhere and you can't get away from them, and you can't get any other opinions, and they're scuppering it all. So not so good for me.
Tell me a bit more about what the issues were with her and why you felt that way?
There were a few different issues. Basically she was a very nice lady, very chatty, affable. I think she genuinely wanted to help and meant well. Her personal skills, her interaction skills were good. I just think it was basically a lack of knowledge, a lack of, either a lack of training or a lack of ability to retrain, retain the information and training that she had had. So that was an incompetence area, really.
What sort of things?
She, also I think she was too, she didn't really stick up for you enough. She was too easily swayed by if a doctor said, 'I want to do this,' then her role is really to support the woman, and she didn't really. She sort of tried to persuade the woman to do what the doctor said, because she felt very subdued by the doctor. I don't think she was very confident within her role.
One Muslim mother was worried about what she would do if she had to be seen by a male member of staff, as she would not feel comfortable with this.
As a Muslim, she feels more comfortable being seen by a female member of staff. (Audio clip in...
I have not had to deal with men so far, but if I did, I would say I only want a woman. It's difficult with men, it's better if a woman can be arranged.
How will you explain if you are faced with a problem like that? For example, what reason will you give for wanting to be seen by a woman?
I am a Muslim, that's the first thing, that other men - my friend, she did not have a baby for four years, but she said she had no choice, so she had a check-up, inside, but she did not like it and she still worries about it being a sin or not. Because we are forbidden in Islam, so I worry about that also - that if there was a problem like that and I had to be checked up by a man, then I would not like it, I think.
There is a pressure on your mind?
Yes, God forbid if some thing like that happened - having a check-up done by men.
But what if there is no other way, like a life or death situation?
Well I suppose in that situation you have to do it, but if arrangements can be made - you know there are a lot of Muslims here, they should make arrangements for Muslim women.
Pregnant women with particular needs will be offered more specialised antenatal care. See sections on:
- Pregnancy with a medical condition or disability
- Rarer complications
- Bleeding and miscarriage
- Other conditions in pregnancy
An important part of antenatal care is screening the baby for problems, using scans and blood tests. Healthtalk website has a separate site just on Antenatal screening or see the NHS's booklet 'Screening tests for you and your baby’.
Last reviewed May 2017.
Last updated May 2017.