There are differences around the UK which may affect exactly how you are cared for in your pregnancy. For example, if you are in a large town or city you may be assigned to a team of midwives who share your casenotes, but in a smaller town or village it might be your GP or one midwife who oversees all your tests and check-ups and even attends the birth. However, there are certain people who are likely to encounter at some stage over the next nine months, so who are they and what do they do?
When you think you might be pregnant or have done a home pregnancy test, your first port of call to set up your chain of antenatal care is your GP (General Practitioner), or family doctor.
At your first visit your GP will want to do a test to confirm your pregnancy by taking a urine sample. You’ll be asked for the date of the first day of your last menstrual period and be given an estimated due date. Your doctor may wish to discuss your gynaecological history, will probably give you some guidelines on health and nutrition in pregnancy and will set the ball rolling to sort you out with your first midwife appointment.
Along with your midwife, your GP will continue to be your main medical support throughout pregnancy. If you have any questions or health concerns relating to your pregnancy then your doctor or midwife should usually be your first point of contact. Your GP will refer you to hospital for scans and may refer you to hospital or a particular obstetrician if there are any problems that need investigating.
Your GP is not usually involved in labour and birth itself, but once you are back home following birth the general healthcare of both you and your baby reverts back to your doctor, although your midwife will continue to be involved for the first few days.
The midwife/midwifery team
Midwives are specially trained in health care for pregnant women and new babies and are usually the mainstay of your antenatal care. Exactly how the provision of midwives works under the NHS varies from area to area: your midwife may be attached to your GP’s surgery or to a local hospital or may be attached to a local health centre.
You may be cared for by a single midwife, whom you come to know quite well, or by a team of midwives who share the task of supporting you through pregnancy, birth and into the first six weeks of motherhood. Once home after giving birth you will usually have a daily visit from a midwife for the first ten or so days.
Under the midwives’ code of conduct they are qualified to conduct antenatal check-ups and scans and deliver babies using procedures such as episiotomies when necessary: midwives do not investigate complications in pregnancy nor handle complications in birth such as forceps deliveries and c-sections. A midwife will always be present to assist during the birth of your child, and the presence of a doctor will only be necessary in the event of complications, although doctors are usually present at most hospital births. As most midwives work in shifts and you, obviously, can’t control when your child arrives, you can’t usually choose which midwife will help at the birth.
This is a doctor who specialises in pregnancy and birth; an obstetrician is often also a gynaecologist. You are likely to see an obstetrician if you are booked in for a hospital delivery, or you have complications during pregnancy that need investigating and/or treating. With some pregnancy conditions you may be seen by another doctor specialising in that condition (such as gestational diabetes). When you book a hospital birth, the ultimate responsibility for your care is given to a consultant obstetrician. However, if you have a normal, healthy pregnancy and birth there might well be no occasion at all for you to see your consultant obstetrician as care will be largely delegated to midwives and less senior doctors who work under the supervision of the consultant.
During your pregnancy you will usually have two major ultrasound scans to check on your baby’s development at around 12 and 20 weeks. In a normal, healthy pregnancy you probably won’t need any more scans, but if you experience any bleeding during pregnancy, or there are other signs of complications then you may have more. Your scans won’t necessarily be given by the same person and the sonographers may also be qualified midwives or obstetricians.
If you have an epidural or other form of anaesthetic for delivery then you will come in contact with an anaesthetist, a specialist doctor responsible for administering anaesthetics for pain-relief and surgery.
Paediatricians are specialist doctors in the area of baby and child care. Your baby will be checked by a paediatrician within a few hours of the birth if you have had a normal, healthy pregnancy and delivery. If there have been any pregnancy complications a paediatrician may help advise on the best options for birth and will be on hand to check your baby as soon as he or she is born. If there are any health complications with your new born baby then s/he will be placed under the care of a paediatrician until fully well.
In hospitals nurses will work alongside midwives and doctors to give you medical help and support through birth and throughout your stay in hospital. Labour and delivery nurses will have special training to enable them to play a supportive role, as well as administering medicines, monitoring mother and baby and providing initial postnatal care.
Interested in private options for your antenatal care? We explain what doulas, independent midwives and maternity nurses are all about.
Independent midwives are a common choice for those hoping for a home birth.
If establishing a rapport with the midwife who will assist at the birth is important to you, then you might want to consider hiring an independent midwife. With independent midwives you will have to pay a fee, but you will be able to meet a few before choosing who you would like to be looked after by and will then have continuity of care throughout pregnancy, birth and postpartum. Your can find details of local midwife professionals through the Independent Midwives Organisation. Independent midwives are a common choice for those hoping for a home birth. Some NHS areas do run schemes for one-to-one midwifery so it’s worth asking if it’s an available option.
Doulas are women who support mothers-to-be in pregnancy and birth and, if required, beyond. In ancient Greek, ‘doula’ means handmaiden or care-giver, and today they are an extra source of non-medical support, advice and practical help for expectant women. While Doulas have no medical training, they may have had training in non-medical pain relief (such as aromatherapy, massage and reflexology) and emotional support for pregnancy and birth. Many have no training other than their own experiences of pregnancy, childbirth and motherhood, and years of experience in helping other mums.
Whether it’s helping you decide what kind of labour you’d like and where you’d like to give birth; injecting some calm, reassurance and cheerleading into the delivery room; helping you get to grips with breastfeeding or simply helping out with daily chores when you return home, a doula can provide support in countless ways.
Research has shown that having continuity of care – whether from a midwife or a doula – throughout pregnancy through to the early days of motherhood has a positive impact on birthing experiences and lowers the chance of medical intervention during birth. If continuity of care is important to you, but an independent midwife is prohibitively expensive or you’d simply like a more low-key option for support, then hiring a doula may be the answer.