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United Kingdom Prenatal Care Schedule

This is a general overview of the prenatal visits many people in the United Kingdom are offered during pregnancy, drawn from public guidance by NICE and the WHO. Every pregnancy is different — your own care provider decides which checks and timing are right for you. It's here for reference and orientation, not as medical advice.

Disclaimer: BabyBerry is for general information and self-tracking. It is not a medical device and does not provide medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider.
  1. Booking Appointment — Weeks 8–10
  2. Dating Scan and Combined Screening — Weeks 11–14
  3. 16-Week Review Appointment — Week 16
  4. Anomaly Scan (20-Week Scan) — Weeks 18–20
  5. 25-Week Appointment (First Pregnancy Only) — Week 25
  6. Blood Tests, Anti-D, and RSV Vaccine — Week 28
  7. 31-Week Appointment (First Pregnancy Only) — Week 31
  8. Birth Preparation — Week 34
  9. Presentation Check — Week 36
  10. 38-Week Appointment — Week 38
  11. 40-Week Appointment (First Pregnancy Only) — Week 40
  12. Induction Planning — Week 41

Booking Appointment

First prenatal visit · Weeks 8–10

Full medical history, baseline bloods, infectious disease screening, sickle cell and thalassaemia screening, risk assessments

Good to know: The booking appointment is the most comprehensive antenatal visit in the UK. It is typically led by a midwife — not an obstetrician — reflecting the NHS midwife-led model of care. You will have a full set of blood tests, risk assessments, and a thorough discussion of your medical and family history. Unlike the US, the UK does not screen for rubella (removed in 2016 as the population is considered well-immunised) and does not routinely screen for hepatitis C. Sickle cell and thalassaemia screening is unique to the UK programme and should ideally be completed before 10 weeks. All screening tests are optional — your midwife will explain each one so you can make an informed choice.

Common checks

  • Height, Weight, and BMI — Your midwife will measure your height and weight to calculate your body mass index (BMI). BMI is used to assess your risk for gestational diabetes, pre-eclampsia, and other complications. A BMI of 30 or above is a risk factor for GDM and may mean additional monitoring throughout your pregnancy.
  • Blood Pressure — Blood pressure is measured at every antenatal appointment. This first reading establishes your baseline. A rise in blood pressure later in pregnancy, particularly combined with protein in the urine, could indicate pre-eclampsia, a serious condition requiring close monitoring or early delivery.
  • Urine Dipstick (Proteinuria) — A urine sample is tested using a dipstick for protein, glucose, and signs of infection. Protein in the urine can indicate kidney problems or, later in pregnancy, pre-eclampsia. Glucose may suggest gestational diabetes. This quick test is done at every antenatal appointment.
  • Full Blood Count (FBC) — A full blood count measures your red blood cells, white blood cells, haemoglobin, and platelets. It checks for anaemia, which is common in pregnancy and can cause fatigue and complications if untreated. If your haemoglobin is low, iron supplements will be recommended. FBC is rechecked at 28 weeks.
  • Blood Group and Rh Status — This test determines your blood group (A, B, AB, or O) and whether you are Rh-positive or Rh-negative. About 15% of women are Rh-negative. If you are Rh-negative, you will be offered anti-D immunoglobulin injections at 28 weeks (and after any bleeding) to prevent your immune system from producing antibodies that could harm an Rh-positive baby in this or future pregnancies.
  • Red Cell Antibodies — This blood test screens for antibodies against red blood cells that could cross the placenta and attack the baby's blood cells. Irregular antibodies can develop from previous pregnancies or blood transfusions. If significant antibodies are found, you will be referred for specialist monitoring.
  • HIV Screening — HIV screening is offered to all pregnant women in the UK as part of the NHS Infectious Diseases in Pregnancy Screening programme. If detected early, antiretroviral treatment during pregnancy can reduce mother-to-baby transmission to less than 1%. The test is confidential and all screening is optional.
  • Hepatitis B Screening — All pregnant women in the UK are offered hepatitis B screening. Hepatitis B can be passed to the baby during birth. If you test positive, your baby will be given the hepatitis B vaccine at birth plus additional doses, which is highly effective at preventing infection. Note: unlike some countries, the UK does not routinely screen for hepatitis C in pregnancy.
  • Syphilis Screening — Syphilis screening is offered to all pregnant women. Untreated syphilis during pregnancy can cause miscarriage, stillbirth, or congenital syphilis in the baby. If detected, syphilis is effectively treated with antibiotics, and early treatment prevents harm to the baby.
  • Sickle Cell and Thalassaemia Screening — The UK offers screening for sickle cell disease and thalassaemia to all pregnant women, ideally before 10 weeks. These are inherited blood disorders that affect haemoglobin. If you are identified as a carrier, your partner will also be offered testing. If both parents are carriers, there is a 1 in 4 chance the baby could be affected, and you will be offered genetic counselling and diagnostic testing.
  • Mental Health Assessment — Your midwife will ask about your mental health, including any history of depression, anxiety, or other mental health conditions. Perinatal mental health problems are common and treatable. This assessment helps identify women who may benefit from additional support, counselling, or referral to specialist perinatal mental health services.
  • VTE Risk Assessment — Venous thromboembolism (VTE) — blood clots in the legs or lungs — is more common in pregnancy. Your midwife will assess your risk factors including BMI, age, family history, immobility, and previous VTE. If you are at higher risk, you may be prescribed low-dose aspirin or low-molecular-weight heparin injections.
  • Pre-eclampsia Risk Assessment — Your midwife will assess your risk of developing pre-eclampsia based on factors such as first pregnancy, age over 40, BMI over 35, family history, previous pre-eclampsia, or pre-existing conditions like hypertension or kidney disease. If you have one high-risk or two moderate-risk factors, you will be advised to take aspirin 150mg daily from 12 weeks until 36 weeks.
  • GDM Risk Assessment — Your midwife will assess whether you have risk factors for gestational diabetes: BMI of 30 or above, previous baby weighing 4.5kg or more, previous gestational diabetes, family history of diabetes (first-degree relative), or South Asian, Black, or Middle Eastern ethnicity. If risk factors are present, you will be offered a 75g oral glucose tolerance test (OGTT) at 24-28 weeks. The UK does not use the 50g glucose challenge test used in the US.

How to prepare

  • Know the first day of your last menstrual period (LMP) — this is essential for estimating your due date before your dating scan.
  • Gather medical history from both parents' families, including any inherited conditions, blood disorders, diabetes, or high blood pressure.
  • List all medications, vitamins, and supplements you are currently taking, including over-the-counter remedies.
  • Think about your preferences for screening tests — all are optional and your midwife will discuss them, but it helps to have considered them in advance.
  • Prepare questions about your local maternity services, birth options (hospital, midwife-led unit, home birth), and any concerns you have.

Tips

  • This appointment can take 1-2 hours, so allow plenty of time. Bring your partner if possible — they can provide their family history too.
  • Start taking folic acid 400mcg daily (if not already) and vitamin D 10mcg (400 IU) daily. These are recommended throughout pregnancy in the UK. You may be eligible for free Healthy Start vitamins.
  • All screening tests are optional and your midwife will not pressure you. Take time to read the screening leaflets and ask questions before deciding.
  • Ask about your local maternity services — many areas offer a choice of hospital birth, midwife-led birth centre, or home birth.
  • If you smoke, drink alcohol, or use recreational drugs, be honest with your midwife. They are not there to judge — they can connect you with support services to help you and your baby.

Dating Scan and Combined Screening

Visit 1 · Weeks 11–14

Dating ultrasound (CRL measurement), nuchal translucency scan, combined test for Down's/Edwards'/Patau's syndromes

Good to know: The combined test is the UK's primary screening method for Down's, Edwards', and Patau's syndromes — this is different from the US, where NIPT and quad screens are more commonly used as first-line tests. The combined test uses the NT measurement plus blood markers (PAPP-A and free beta-hCG) and has a detection rate of approximately 85% for Down's syndrome. If the result shows a higher chance (1 in 150 or more), you will be offered NIPT (non-invasive prenatal testing) free on the NHS as a further screening step before any diagnostic procedure. If the combined test cannot be done in time (after 14+1 weeks), the quadruple test is offered between 14+2 and 20 weeks.

Common checks

  • Dating Ultrasound (Crown-Rump Length) — The dating scan is usually performed between 11 and 14 weeks. The sonographer measures your baby's crown-rump length (CRL) to accurately determine gestational age and your estimated due date. This scan also confirms the number of babies, checks for a heartbeat, and provides a basic structural check. The due date from this scan is more accurate than one based on your last menstrual period.
  • Nuchal Translucency (NT) Measurement — If you choose to have screening for Down's, Edwards', and Patau's syndromes, the sonographer will measure the fluid-filled space at the back of your baby's neck (nuchal translucency). A larger-than-average measurement may indicate a higher chance of these conditions. The NT measurement is combined with blood test results and your age to calculate an overall risk. This measurement must be done before 14 weeks and 1 day.
  • Combined Test Blood Draw (PAPP-A and Free Beta-hCG) — As part of the combined test, a blood sample is taken to measure two proteins: pregnancy-associated plasma protein-A (PAPP-A) and free beta-hCG. These levels, combined with the NT measurement and your age, produce a risk estimate for Down's syndrome (trisomy 21), Edwards' syndrome (trisomy 18), and Patau's syndrome (trisomy 13). A result of 1 in 150 or higher chance is considered "higher chance" in the UK. If higher chance, NIPT is offered free on the NHS.

How to prepare

  • You may need a partially full bladder for the scan — drink a glass of water about an hour beforehand. Your hospital letter may give specific instructions.
  • The blood test and scan are usually done at the same visit. No fasting is required.
  • Decide in advance whether you want screening for Down's, Edwards', and Patau's syndromes — it is optional. Read the NHS screening leaflet sent with your appointment letter.
  • Wear comfortable clothing that allows easy access to your abdomen and your arm (for the blood draw).

Tips

  • The dating scan may change your estimated due date — the CRL measurement is more accurate than dates based on your last period, especially if your cycles are irregular.
  • The scan typically takes about 20 minutes. You will see your baby on screen and can usually take home printed photos.
  • A "higher chance" result does not mean your baby has a condition. Most women with a higher chance result go on to have an unaffected baby. NIPT or diagnostic testing will help clarify.
  • If you are having twins or multiples, the screening process may differ slightly. Your midwife will explain the options for your specific situation.

16-Week Review Appointment

Visit 2 · Week 16

Review screening results, blood pressure and urine, discuss pertussis vaccine

Good to know: The 16-week appointment is a shorter review visit, but it is important for discussing all your screening results and planning the next steps. The whooping cough (pertussis) vaccine is strongly recommended in the UK — it protects your baby from birth until they receive their own vaccine at 8 weeks old. Whooping cough can be life-threatening in very young babies who are too young to be vaccinated themselves.

Common checks

  • Blood Pressure — Routine blood pressure check to monitor for any upward trend from your booking baseline. Consistent readings are reassuring; any significant increase will be investigated further.
  • Urine Dipstick — A quick urine test to check for protein, glucose, and infection markers. Persistent proteinuria or glucosuria at this stage will prompt further investigation.
  • Review of Screening Results — Your midwife will discuss the results of all blood tests and screening from the booking appointment and dating scan. If any results need further action, such as a higher-chance combined test result requiring NIPT or diagnostic testing, this will be arranged. This is a good time to ask any questions about results you did not understand.
  • Pertussis (Whooping Cough) Vaccine Discussion — Your midwife will discuss the pertussis (whooping cough) vaccine, which can be given from 16 weeks of pregnancy. The vaccine stimulates your body to produce antibodies that cross the placenta and protect your newborn for the first few months of life, before they can receive their own vaccinations. It is approximately 92% effective at preventing whooping cough in newborns. Ideally given around 20 weeks, but must be before 32 weeks.

How to prepare

  • Bring your maternity notes (handheld records) to every appointment.
  • Write down any questions about your screening results or symptoms you have been experiencing.
  • Think about whether you would like to have the whooping cough vaccine at this visit or a later one.

Tips

  • This is a good time to start planning your anomaly scan (18-20 weeks). Check your appointment letter for the date and any preparation instructions.
  • If you have not already, discuss your mental health with your midwife. Mood changes are common in pregnancy and support is available.
  • You may start feeling fetal movements from around 16-24 weeks. First-time mothers usually notice them closer to 20-22 weeks.
  • Ask your midwife about antenatal classes available in your area — NHS classes are free and popular ones book up quickly.

Anomaly Scan (20-Week Scan)

Visit 3 · Weeks 18–20

Detailed structural ultrasound screening for 11 conditions, placenta location, amniotic fluid check

Good to know: The anomaly scan is one of the most important scans in UK antenatal care. It screens for 11 specific conditions with varying detection rates — importantly, a normal scan does not guarantee a 100% healthy baby, as some conditions are too subtle to see on ultrasound or may develop later. If an abnormality is found or suspected, you will be referred to a fetal medicine specialist for further assessment, which may include more detailed scans or diagnostic tests. A low-lying placenta at this stage is common and usually resolves — only about 1 in 200 women still have placenta praevia at the time of delivery.

Common checks

  • Fetal Anomaly Scan — The anomaly scan is a detailed ultrasound that screens for 11 physical conditions: anencephaly (98% detection rate), open spina bifida (90%), cleft lip (75%), diaphragmatic hernia (60%), gastroschisis (98%), exomphalos (80%), serious cardiac abnormalities (50%), bilateral renal agenesis (84%), lethal skeletal dysplasia (60%), Edwards' syndrome/T18 (95%), and Patau's syndrome/T13 (95%). The sonographer will systematically examine your baby's brain, spine, face, heart, stomach, kidneys, limbs, and other structures. This is a screening scan, not a diagnostic test — it cannot detect all abnormalities.
  • Placenta Location Check — During the scan, the sonographer notes where the placenta is positioned. If the placenta is low-lying (within 20mm of the internal cervical os), a follow-up scan will be arranged at approximately 32 weeks. In most cases, the placenta moves upward as the uterus grows and the issue resolves by the third trimester.
  • Amniotic Fluid Assessment — The volume of amniotic fluid around the baby is checked. Too much (polyhydramnios) or too little (oligohydramnios) can indicate conditions that need monitoring. Normal fluid levels are reassuring.
  • Whooping Cough Vaccine (if not yet given) — If you did not receive the whooping cough vaccine at your 16-week visit, it is often offered at or around the anomaly scan appointment. Around 20 weeks is considered the ideal timing to maximise antibody transfer to the baby.

How to prepare

  • Wear loose, comfortable clothing — ideally a two-piece outfit so you can expose your abdomen easily.
  • You may need a partially full bladder. Drink a glass of water about an hour before, but do not drink excessively.
  • The scan takes 20-30 minutes. If the baby is in a difficult position, you may be asked to walk around and return.
  • Decide beforehand if you want to know the baby's sex — not all hospitals will tell you, so check in advance.

Tips

  • If the sonographer is quiet during the scan, do not worry. They are concentrating on obtaining precise measurements of many different structures.
  • A normal scan is very reassuring, but remember it is a screening tool, not a guarantee. Some conditions cannot be detected by ultrasound.
  • Ask for printed photos or a digital copy of the ultrasound images to keep. Many hospitals offer these, sometimes for a small donation.
  • If anything concerning is found, try to stay calm. Many findings need further investigation but turn out to be nothing serious. Your care team will guide you through the next steps.

25-Week Appointment (First Pregnancy Only)

Visit 4 · Week 25

Fundal height begins, blood pressure, urine check, fetal movements discussion

Good to know: This appointment is only for first-time mothers (nulliparous women) and is an additional visit in the NICE schedule. The UK uses customised GROW (Gestation Related Optimal Weight) charts for plotting fundal height, which take into account maternal characteristics and are better at detecting babies that are small or large for gestational age. From 24 weeks, reduced fetal movements should always be reported promptly — this is one of the most important things you can do to protect your baby. Also begin sleeping on your side from 28 weeks onwards, as research shows this reduces the risk of stillbirth.

Common checks

  • Blood Pressure — Continued routine monitoring. Blood pressure tends to decrease slightly in the second trimester before rising in the third. Any significant rise from baseline is flagged.
  • Urine Dipstick — Routine urine test for protein, glucose, and signs of infection. Proteinuria combined with rising blood pressure can indicate pre-eclampsia.
  • Symphysis-Fundal Height (SFH) Measurement — From 24-25 weeks, your midwife will measure the distance from your pubic bone to the top of your uterus with a tape measure. In the UK, measurements are plotted on customised GROW charts that account for your height, weight, ethnicity, and parity, making them more accurate than standard charts. If the measurement is significantly above or below the expected range, a growth scan will be arranged.
  • Fetal Movements Discussion — Your midwife will ask about your baby's movements and explain what is normal. From 24 weeks, you should contact your maternity unit immediately if you notice your baby is moving less than usual. There is no set number of kicks to count — what matters is knowing your baby's usual pattern and noticing any reduction.

How to prepare

  • Bring your maternity notes — your midwife will plot the fundal height on your GROW chart.
  • Start paying attention to your baby's movement patterns so you know what is normal for your baby.
  • Note any symptoms you want to discuss, such as swelling, headaches, or visual disturbances.

Tips

  • Never hesitate to contact your maternity unit if you are worried about reduced fetal movements. They would always rather check and reassure you than have you wait at home.
  • Start sleeping on your side from 28 weeks — either side is fine. Research shows this reduces the risk of stillbirth compared to sleeping on your back.
  • If you have not started antenatal classes yet, now is a good time. They cover labour, birth, feeding, and caring for your newborn.
  • Consider starting to think about your birth preferences — where you want to give birth, pain relief options, and who you want with you.

Blood Tests, Anti-D, and RSV Vaccine

Visit 5 · Week 28

FBC recheck, antibody recheck, anti-D for Rh-negative, RSV vaccine, GDM screening if indicated

Good to know: The 28-week appointment is one of the busiest visits with several important interventions. Anti-D prophylaxis is a well-established, safe treatment that prevents serious complications in Rh-negative pregnancies. The RSV vaccine is new to the NHS (2024) but has strong evidence behind it — RSV is the leading cause of infant hospitalisation in winter. A key UK-specific difference: gestational diabetes screening uses the 75g OGTT directly and is only offered to women with risk factors. In the US, all women receive a 50g glucose challenge test first. If your OGTT results show GDM, you will be referred to a specialist diabetes team.

Common checks

  • Blood Pressure — Blood pressure monitoring becomes increasingly important in the third trimester. Rising blood pressure can be an early sign of pre-eclampsia and needs prompt assessment.
  • Urine Dipstick — Routine urine check for protein, glucose, and infection. Combined with blood pressure, this helps screen for pre-eclampsia.
  • Symphysis-Fundal Height (SFH) — Continued measurement plotted on your GROW chart. A measurement that crosses centile lines or falls outside the expected range may indicate the baby is growing too quickly or too slowly and will trigger a growth ultrasound.
  • Full Blood Count (FBC) Recheck — A repeat full blood count checks your haemoglobin level for anaemia, which is common in the third trimester as blood volume increases. If anaemia is found, iron supplementation will be prescribed. Take iron tablets with vitamin C (e.g., a glass of orange juice) to aid absorption, and avoid taking them with tea, coffee, or calcium-rich foods.
  • Red Cell Antibodies Recheck — A repeat antibody screen checks whether any new antibodies have developed since the booking appointment. This is particularly important for Rh-negative women, but is done for all women.
  • Anti-D Prophylaxis (Rh-Negative Women) — If you are Rh-negative, you will be offered anti-D immunoglobulin injection at 28 weeks. This prevents your immune system from producing antibodies against an Rh-positive baby's blood cells, which could cause haemolytic disease of the newborn in this or future pregnancies. The injection is very safe and has been used for decades. Most hospitals now use a single 1500 IU dose, though some still use a two-dose regimen.
  • RSV Vaccine (Abrysvo) — From 2024, the NHS offers the RSV (respiratory syncytial virus) vaccine (Abrysvo) to pregnant women from 28 weeks. RSV is a very common virus that can cause bronchiolitis in babies. The vaccine stimulates your body to make antibodies that pass to your baby through the placenta, protecting them for the first 6 months of life when RSV is most dangerous. The vaccine is well-studied and has been shown to significantly reduce severe RSV illness in young infants.
  • 75g Oral Glucose Tolerance Test (OGTT) — If Risk Factors Present — If you have risk factors for gestational diabetes (BMI ≥30, previous baby ≥4.5kg, family history of diabetes, previous GDM, or South Asian/Black/Middle Eastern ethnicity), you will be offered a 75g OGTT between 24-28 weeks. You must fast overnight (8-14 hours). A fasting blood sample is taken, you drink a 75g glucose solution, and another blood sample is taken 2 hours later. The UK uses a 75g OGTT directly — there is no preliminary 50g glucose challenge test as used in the US. GDM screening is risk-factor based in the UK, not offered to everyone.

How to prepare

  • If you are having the OGTT: fast overnight for 8-14 hours beforehand. Water is fine. The test takes about 2 hours, so bring something to read or do.
  • If you are Rh-negative, be aware that you will likely receive the anti-D injection at this visit. The injection is given in the arm or buttock.
  • Bring your maternity notes and any questions about third trimester symptoms, birth planning, or the RSV and whooping cough vaccines.
  • If you have not had the whooping cough vaccine yet, ask about having it at this visit — it should be given before 32 weeks.

Tips

  • The anti-D injection is very safe and has been used since the 1960s. Side effects are usually mild — a sore arm for a day or two.
  • The RSV vaccine is a single dose, given in the arm. It is new to the UK programme but has been well-studied internationally. Side effects are similar to other vaccines (sore arm, mild tiredness).
  • If you are diagnosed with GDM, do not panic. Most women manage it well with diet and exercise changes. Only a small proportion need medication.
  • The OGTT glucose drink can taste very sweet. Some women find it easier to drink it cold. If you vomit within 30 minutes, the test may need to be repeated.

31-Week Appointment (First Pregnancy Only)

Visit 6 · Week 31

Review 28-week blood results, blood pressure, urine, fundal height

Good to know: This appointment is only for first-time mothers and provides a check-in between the busy 28-week visit and the 34-week appointment. If anaemia was found at 28 weeks, iron supplementation is important — take iron with vitamin C to help absorption, and avoid taking it at the same time as tea, coffee, or calcium supplements. Most women with iron-deficiency anaemia will see their haemoglobin improve within 2-4 weeks of starting supplements.

Common checks

  • Blood Pressure — Routine monitoring. In the third trimester, blood pressure is checked carefully at every visit as pre-eclampsia can develop rapidly.
  • Urine Dipstick — Continued routine urine check. New-onset proteinuria in the third trimester, especially with raised blood pressure, requires urgent assessment.
  • Symphysis-Fundal Height (SFH) — Continued plotting on your GROW chart to monitor the baby's growth trajectory. Consistent growth along a centile line is reassuring.
  • Review of 28-Week Blood Results — Your midwife will review the results of the full blood count and antibody screen from 28 weeks. If anaemia was found, iron supplementation should have been started and your midwife will check how you are getting on. If new antibodies were found, you may be referred for specialist monitoring.

How to prepare

  • Bring your maternity notes for the growth chart update.
  • If you were started on iron supplements, be ready to discuss how you are tolerating them (common side effects include constipation and dark stools).
  • Write down any questions about the third trimester, birth planning, or symptoms you are experiencing.

Tips

  • If iron tablets are causing constipation, ask your midwife about liquid iron supplements or adjusting the dose. Eating high-fibre foods and drinking plenty of water also helps.
  • This is a good time to start thinking about packing your hospital bag. Have it ready by 36 weeks just in case.
  • If you are feeling breathless, this is normal — your growing uterus is pushing against your diaphragm. Sitting upright and sleeping propped up can help.
  • Continue monitoring fetal movements daily. Report any changes to your maternity unit — do not wait until your next appointment.

Birth Preparation

Visit 7 · Week 34

Blood pressure, urine, fundal height, second anti-D if applicable, birth planning discussion

Good to know: This appointment focuses on preparing you for birth. A key difference from US practice: the UK does not perform routine cervical exams in late pregnancy. Research shows that cervical dilation before labour is a poor predictor of when labour will begin, so the NHS does not include it as routine. The UK also does not routinely screen for Group B Streptococcus (GBS) — instead, intrapartum antibiotics are given based on risk factors. The whooping cough vaccine should have been given by this point. Make sure your hospital bag is packed and your birth partner knows the plan.

Common checks

  • Blood Pressure — Careful blood pressure monitoring continues. Pre-eclampsia is most common in the third trimester, particularly from 34 weeks onwards.
  • Urine Dipstick — Routine urine check. Protein in the urine at this stage, combined with elevated blood pressure, is a red flag for pre-eclampsia.
  • Symphysis-Fundal Height (SFH) — Continued growth monitoring plotted on your GROW chart. Any crossing of centile lines will be investigated with an ultrasound.
  • Second Anti-D Dose (If Two-Dose Regimen) — If your hospital uses a two-dose anti-D regimen for Rh-negative women, the second dose is given at 34 weeks. Many hospitals now use a single larger dose at 28 weeks, in which case no further injection is needed here.
  • Birth Planning Discussion — Your midwife will discuss birth planning including recognising the signs of labour, when to go to hospital, pain management options (water birth, gas and air, pethidine, epidural), and writing your birth preferences. You will also discuss options for caesarean section if relevant. Importantly, the UK does not perform routine cervical exams in late pregnancy — this is a key difference from the US.

How to prepare

  • Start thinking about your birth preferences: where you want to give birth, pain relief options, who you want with you, and what happens after the birth.
  • Bring your maternity notes and any questions about labour, pain management, or post-birth care.
  • Have your hospital bag packed or nearly packed by this appointment.

Tips

  • The UK does not routinely screen for Group B Strep (GBS). If you want to know your GBS status, private testing is available between 35-37 weeks using an ECM swab. Discuss this with your midwife.
  • Write down your birth preferences and share them with your midwife and birth partner. Keep them flexible — birth rarely goes exactly to plan, and that is okay.
  • Make sure your birth partner knows the route to the hospital and where to park, even in the middle of the night.
  • If you have not yet discussed infant feeding with your midwife, this is a good time. The NHS supports breastfeeding but also supports your choice whatever it is.

Presentation Check

Visit 8 · Week 36

Baby's presentation check, breech management, breastfeeding info, vitamin K, postnatal depression awareness

Good to know: The 36-week presentation check is a critical appointment. About 3-4% of babies are still breech at term. The UK offers ECV (external cephalic version) free on the NHS, and NICE recommends discussing all options — ECV, planned vaginal breech birth, and elective caesarean. Importantly, the UK does not routinely screen for Group B Streptococcus (GBS). The NHS uses a risk-factor based approach: antibiotics during labour are given if you previously had a baby affected by GBS, if GBS is detected incidentally during pregnancy, if you develop a fever during labour, or if your waters break prematurely. Private GBS testing (ECM swab) is available at 35-37 weeks if desired.

Common checks

  • Blood Pressure — Continued close monitoring. Pre-eclampsia can develop at any time in the third trimester and requires immediate attention.
  • Urine Dipstick — Routine urine test for protein, glucose, and infection markers.
  • Symphysis-Fundal Height (SFH) — Continued growth monitoring. The growth curve should show a steady upward trend following a centile line.
  • Abdominal Palpation for Presentation — Your midwife will feel your abdomen to determine whether your baby is head-down (cephalic), bottom-first (breech), or lying sideways (transverse). Most babies are head-down by 36 weeks. If a breech presentation is suspected, an ultrasound will be arranged to confirm the position.
  • ECV Discussion (If Breech) — If your baby is breech, you will be offered external cephalic version (ECV) — a procedure where a doctor gently turns the baby head-down by applying pressure on your abdomen. ECV is successful in about 50% of cases and is offered free on the NHS. Alternatives include planned vaginal breech birth (at selected centres with experienced staff) or elective caesarean section.
  • Breastfeeding and Newborn Care Information — Your midwife will provide information about breastfeeding, including the benefits, how to get started, and where to find support. You will also discuss newborn care topics including vitamin K (given to prevent a rare bleeding disorder), newborn screening tests, and the importance of recognising signs of postnatal depression in the weeks after birth.

How to prepare

  • Your hospital bag should be ready by now. Include items for you and baby, your birth preferences, and your maternity notes.
  • If you suspect your baby might be breech (you feel kicks low down or a hard round head at the top), mention it to your midwife.
  • Think about your preferences for vitamin K for the baby (injection or oral drops) and whether you want to breastfeed.
  • Prepare any questions about what to expect during labour, pain relief, and the early postnatal period.

Tips

  • If your baby is breech, ECV is worth considering. It has about a 50% success rate and is a safe procedure performed under ultrasound guidance. If it does not work, you still have options.
  • If you are interested in private GBS testing, arrange it between 35-37 weeks. The swab can be done at home or by your GP. A positive result means antibiotics in labour, not a caesarean.
  • Rest as much as you can in these final weeks. Nap when you can, eat well, and stay hydrated.
  • Vitamin K injection is recommended for all newborns to prevent a rare but serious bleeding condition. The injection is the most effective option, with oral drops as an alternative.

38-Week Appointment

Visit 9 · Week 38

Blood pressure, urine, fundal height, discuss post-dates management and membrane sweep option

Good to know: From this point, appointments focus on monitoring your wellbeing and the baby's health while awaiting labour. NICE recommends discussing induction at 41+0 weeks, as evidence shows a small but measurable increase in complications after this point. A membrane sweep can be offered from 39 weeks — it is a simple procedure performed by a midwife during a vaginal examination, where the membranes around the baby are swept away from the cervix. Studies show it increases the chance of labour starting naturally by about 20%, reducing the need for formal induction.

Common checks

  • Blood Pressure — Close monitoring continues in these final weeks. Any new rise in blood pressure needs urgent assessment.
  • Urine Dipstick — Routine check for protein and glucose. New proteinuria at this stage is treated seriously.
  • Symphysis-Fundal Height (SFH) — Final growth checks plotted on the GROW chart. The baby may "engage" (drop lower into the pelvis), which can cause the fundal height to plateau or decrease slightly.
  • Post-Dates Management Discussion — Your midwife will discuss what happens if your pregnancy goes past your due date. NICE recommends that induction of labour is discussed and offered at 41 weeks. A membrane sweep can be offered from 39 weeks to encourage labour to start naturally. Understanding these options in advance helps you make informed decisions when the time comes.

How to prepare

  • Make sure your birth partner is available and contactable at all times from now on.
  • Confirm your route to the hospital or birth centre, including parking arrangements.
  • Think about whether you would like a membrane sweep if offered from 39 weeks onwards.
  • Double-check your hospital bag has everything you need for you, baby, and your birth partner.

Tips

  • A membrane sweep is not compulsory and you can decline it. It may cause some discomfort, cramping, and a "show" (mucus plug) afterwards, which is normal.
  • Signs that labour may be starting: regular contractions that get stronger and closer together, your waters breaking, a "show" (blood-tinged mucus), lower back pain, or an urge to go to the toilet.
  • If your waters break before contractions start, contact your maternity unit. They will advise whether to come in or wait for contractions to begin.
  • Try to rest, eat well, and stay calm. Labour will come when it is ready, and you are well-prepared.

40-Week Appointment (First Pregnancy Only)

Visit 10 · Week 40

Blood pressure, urine, fundal height, membrane sweep may be offered, induction discussion

Good to know: Going past your due date is very common for first-time mothers — only about 5% of babies arrive on their estimated due date. This appointment is only in the schedule for first pregnancies. A membrane sweep at 40 weeks can help avoid formal induction at 41 weeks. It is completely your choice. Many first-time mothers go into labour between 40 and 41 weeks, so patience is key. Continue to monitor fetal movements and contact your maternity unit if you have any concerns.

Common checks

  • Blood Pressure — Routine monitoring at each visit. Report any sudden headaches, visual disturbances, or swelling to your midwife immediately.
  • Urine Dipstick — Routine urine test. Vigilance for pre-eclampsia signs continues right up to delivery.
  • Symphysis-Fundal Height (SFH) — Growth monitoring continues. At 40 weeks, the baby is considered full term.
  • Membrane Sweep — A membrane sweep may be offered at this appointment. During a vaginal examination, the midwife inserts a finger through the cervix and sweeps it around, separating the membranes from the cervix. This releases prostaglandins that can help trigger labour. It is about 20% more likely to start labour than no intervention. The procedure can be uncomfortable but is quick. You can always decline or ask to stop.
  • Induction Discussion — Your midwife will discuss the option of induction of labour if you have not gone into labour by 41 weeks. This is a discussion, not a requirement — the decision is yours. Your midwife will explain the process, risks, and benefits so you can make an informed choice.

How to prepare

  • Be prepared for the possibility of a membrane sweep. Wear comfortable clothing and bring a maternity pad in case of spotting afterwards.
  • Continue daily fetal movement monitoring and report any changes immediately.
  • Have your hospital bag packed and your phone charged at all times.

Tips

  • Many first-time mothers go past their due date — this is normal, not a sign that anything is wrong.
  • After a membrane sweep, you may experience cramping, spotting, or a "show." If you develop regular, strong contractions, your labour may be starting.
  • Stay active — gentle walking and staying upright can help encourage labour. Rest when you need to.
  • If you are anxious about going overdue, talk to your midwife. They can help you understand your options and support your decisions.

Induction Planning

Visit 11 · Week 41

Blood pressure, urine, fundal height, membrane sweep, induction offer, monitoring if declined

Good to know: At 41 weeks, NICE recommends offering induction of labour. The evidence shows that after 41 weeks there is a small but real increase in the risk of stillbirth, higher caesarean section rates, and increased chance of the baby needing NICU admission. However, induction is always your choice. The induction process typically involves: cervical ripening with a prostaglandin pessary (like propess or prostin) over 24 hours, then artificial rupture of membranes (ARM/breaking the waters), and an oxytocin drip to stimulate contractions if needed. The whole process can take 1-3 days. If you choose to continue past 41 weeks, twice-weekly monitoring with CTG and amniotic fluid assessment is recommended from 42 weeks.

Common checks

  • Blood Pressure — Vigilant monitoring at this stage. Any rise is taken very seriously as the pregnancy is now post-dates.
  • Urine Dipstick — Routine urine check. Protein levels are closely monitored alongside blood pressure.
  • Symphysis-Fundal Height (SFH) — Growth monitoring continues. The baby is now post-dates and monitoring is focused on ensuring continued wellbeing.
  • Membrane Sweep — A membrane sweep will be offered again if not yet done or can be repeated. At 41 weeks, the sweep may be more effective as the cervix is often more favourable than at 39-40 weeks.
  • Induction of Labour Discussion and Offer — NICE recommends that induction of labour is offered at 41+0 weeks. Your midwife will explain the induction process: typically a prostaglandin pessary or gel to ripen the cervix, followed by artificial rupture of membranes (ARM) and an oxytocin drip if needed. The process can take 1-3 days. Induction is a recommendation, not a requirement — you can decline and opt for increased monitoring instead.
  • Increased Monitoring (If Induction Declined) — If you decline induction, NICE recommends increased monitoring from 42 weeks: twice-weekly cardiotocography (CTG) to monitor the baby's heart rate and an ultrasound to check amniotic fluid levels. This monitoring helps detect any signs that the baby or placenta are not coping well, in which case delivery would be recommended.

How to prepare

  • Have your hospital bag ready and easily accessible — you may be going to the hospital today for induction.
  • Think about your preferences regarding induction vs. continued monitoring. Discuss them with your birth partner before the appointment.
  • Continue monitoring fetal movements right up until delivery.
  • Eat well and rest — if induction begins, it can be a long process.

Tips

  • Induction is a safe, well-established process. Many women have positive induction experiences. The key is to stay informed, ask questions, and be patient — it can take time.
  • If you decline induction, you are not being irresponsible — but do accept the offer of increased monitoring so that your baby's wellbeing can be checked.
  • Pack entertainment for a possible long hospital stay: books, tablet, phone charger, headphones, snacks.
  • Remember: your baby will be here very soon. Whether labour begins naturally or with help, you will meet your baby within days.

Sources

This overview references public guidance from:

Prenatal Care Schedules by Country