Who do I tell that I am pregnant?
As soon as you find out you are pregnant contact your GP or midwife. You will usually be offered your first midwife appointment by the time you are 10 weeks pregnant.
If you are already more than 10 weeks pregnant and have not yet seen your GP or midwife then contact them as soon as possible.
If you have a health condition and have been advised to be seen before 10 weeks then please mention this when you talk to your GP or midwife.
I have a health condition. Who will care for me during my pregnancy?
The basis of care during pregnancy is provided by the community midwife. This remains true for women with medical conditions. During your booking visit the midwife will ask you a series of questions about any previous pregnancies and your mental and physical health. On the basis of this assessment she will discuss with you whether they think it is advisable to have additional care in a hospital and the reasons for this.
Any advice will be based on your personal circumstances and health history. At all stages during pregnancy the team looking after your will take into account your needs and wishes and give you the information that you need to make the best decisions for you and your pregnancy. The pathway outlined here is to explain how the teams ensure that you have access to the most approbate advice to support your decision about your care. At every step the healthcare team will listen to your concerns and wishes to ensure that plans are agreed with you and are the right plans for you and your baby.
There are many reasons why women may be referred to have some of their antenatal care by the obstetric team in hospital. One of the things the Maternal Medicine Network does is to make it clearer which medical conditions may pose higher risks for mums or babies to ensure that the women that need it most are offered additional input into their care.
Antenatal clinics in hospital
Most hospitals run a number of different antenatal clinics to address a different medical or obstetric conditions. In addition to the obstetric team some of the clinics also have specialist midwives (for example specialist diabetes midwives) specialist nurses (for example epilepsy nurse specialists), or additional doctors (such as cardiologist for women with heart problems). Some of the specialist clinics for rarer conditions run less frequently and you may need to be seen at St Georges or St Helier Hospitals.
You will usually be referred to your local hospital in the first instance unless you already receive ongoing care for your condition in one of those hospitals (for example if you have had a renal transplant) and a direct referral is thought to be most appropriate.
What happens during an antenatal clinic visit in hospital?
In clinic staff will go over your medical history and discuss with you how your health conditions might impact your pregnancy and how pregnancy may affect your conditions. The doctors may sometimes advise additional tests to gain a better understanding about you and your condition so that they can best advise you on monitoring and care.
They will also usually discuss your medications. Please bring these with you so that the team can be certain about what you are currently taking. Please also see the medication section on more information on taking medication during pregnancy. For most medications the benefit of taking them is greater than the risk of not taking them. Some should not be stopped suddenly. It is therefore generally not advisable to stop taking your medication without talking to a healthcare professional about this first.
Based on knowledge about you and your conditions the obstetric team will discuss and agree a pregnancy plan with you. In some instances this may involve extra monitoring for you and your baby, for example additional scans. They may also suggest additional treatment for instance Aspirin to try and prevent pre-eclampsia, a pregnancy condition that occurs more commonly in many women with some medical conditions.
You will have the opportunity to explain your concerns and wishes and to ask questions. It is often a good idea to write these down before you attend so that you remember to ask them all.
The maternity team will document the clinic visit and agreed plans in your pregnancy notes (booklet or electronic) so that both you and your community midwife have a record of this. They will also sometimes communicate with other healthcare professionals involved in your care, for instance your GP or other specialist such as your gastroenterologist.
If I have been referred to the hospital does that mean I will have all my pregnancy care there?
The obstetric team may advise that they do not think it is necessary for you to have ongoing care at the hospital and leave you with an ‘Open Appointment’. This means they will not book a specific date for you to come back to see them but they will keep you on their books for the duration of your pregnancy so that you can return for care if necessary. You will of course still have the usual care with your midwife and any routine scans.
For specific conditions or those that may be more risky for you or your baby the obstetric team may recommend referral for an opinion at one of the hub hospitals, St Georges or St Helier.
Alternatively they may ask whether they can take your case for discussion at a specialist MDT. MDTs are Multidisciplinary Team meetings.
What happens at an MDT?
The East Midlands Maternal Medicine Network has set up a series of MDTs for different groups of health conditions. The teams meet monthly and are made up of
- specialists for the health conditions – for example a haematologist (blood specialist) or a rheumatologist
- specialist nurses
- specialist obstetricians who are experts in looking after women with health conditions during pregnancy
- specialist midwives
- usually an obstetric physician – a specialist in looking after medical conditions around the time of pregnancy
- sometimes obstetric anaesthetists.
As a group they will look at your specific details, your wishes and preferences as represented by your obstetrician, and the expertise of your local hospital. Based on this information they will make recommendations for your care during pregnancy, around the time of birth and after birth.
This will either include:
- ongoing care at your local hospital
- or may suggest that you are seen at a teaching hospital.
The recommendations are guided by what the group of experts believe to be the safest for you and your baby, with the aim for you to have as much care close to home as possible.
Your obstetrician will explain the recommendations from the MDT to you. You will have the opportunity to ask questions and discuss the plan.
If I have been referred does this mean I will need to give birth at the teaching hospital?
Not necessarily. For most women who are referred to the MDT the MDT makes recommendations on how you can best be looked after at your local hospital. Sometimes they suggest a visit to the teaching hospital for an assessment or specialist tests to make sure a pregnancy and birth plan is safe and appropriate for you. If the team make plans for specialist care that may not be available at your local hospital or if they believe it is safer for you to give birth where specialist emergency care is available in case it is need they may suggest you give birth at the teaching hospital. The team will discuss the reasons for any recommendations and agree a plan with you.
I have been asked to be seen at the teaching hospital. What can I expect?
If you are asked to attend for a visit at a teaching hospital this will be similar to the one at your local hospital – again please bring your medication and any questions you may have! You may meet more than one specialist as well as specialist midwives and nurses. When the team sees you they may once again suggest additional tests, specific monitoring or a change to your medication. They will also discuss your onward care. This may involve reassurance that further care and birth at your local hospital is safe or a recommendation to give birth at the teaching hospital.
Will I still see my midwife?
Your midwife will continue to be involved in your care. She offers important aspects of your care that the hospitals do not.
Who do I call for help between any appointments?
The team looking after you will explain to you where and how to seek advice and help. This will likely differ for different questions or problems and may commonly include:
- Your community midwife
- The hospital’s maternity advice line
- Your specialist midwife
- Your specialist nurse
- Your GP
- Your consultants
- A&E
