Your first midwife appointment is the start of your maternity care and it can be an exciting or nerve-wracking experience. This blog is here to remind you that you have rights, options and choices in pregnancy - no matter what your story is.

What Happens at Your Booking Appointment?

This usually happens between 8-10 weeks of pregnancy and if you choose NHS maternity care it will likely be your longest appointment. If you choose independent midwifery care, appointments last at least an hour as standard throughout your pregnancy.

The booking appointment is mostly a history-taking session. A midwife will ask you lots of questions about your pregnancy, medical and social history and your general health. You will be offered a heap of tests and screening assessments…which brings us on to our next point.

Everything Offered in Pregnancy is Optional. Yes, Really!

Lots of the things you are offered during pregnancy are so ‘routine’ that they might not seem optional. However you have the right to accept or decline any test, intervention or screening that is offered to you. You might accept everything offered to you. You might want some things but not others. You get to choose. You also can take your time to make decisions, so don’t feel pressured or rushed at your booking appointment if you feel unsure about something that is being offered to you.

What Tests and Checks Are Offered at a Booking Appointment?

Here is a list of what is typically offered at a midwifery booking appointment:

• Blood tests for: HIV, syphilis hepatitis, full blood count, blood group, atypical antibodies, sickle cell & thalassaemia and some hospitals offer an HbA1c test, which screens for type 2 diabetes.
• Basic observations: blood pressure and pulse check.
• Urine test: at least a urine dipstick, some hospitals routinely send a sample off but they should ask your consent to do so and explain what they’re testing for.
• Ultrasound scans: at approximately 12 and 20 weeks. Some hospitals also offer a routine 36 week scan.
• NHS fetal anomaly screening programme information.
• BMI calculation.
• Screening assessments for your chance of having: IUGR/pre-eclampsia, gestational diabetes and venous thromboembolism (VTE).
• Carbon monoxide testing.
• An obstetric or anaesthetic review: if something in your medical or pregnancy history suggests additional input is advise.
• Midwife appointments: at regular intervals throughout your pregnancy.

The results of some of the screening tests may indicate that you should be offered further tests or medication and can impact your ‘risk label’ (see point 4!). You should be given information about everything that is offered to you, so that you can make an informed decision. Whilst we don’t mean to be cynical…a standard NHS booking appointment might only be an hour long, which really isn’t that much time to be able to discuss everything.

Can You Change Your Mind About Pregnancy Care Decisions?

If you decide you do or don’t want something at the booking appointment, you can revisit that decision during your pregnancy. For example…

• Been booked for a glucose tolerance test but not sure that’s what you want? You can change your mind.
• Ticked the 'labour ward' box, but feel more drawn to home birth? You can change your mind.
• Recommended an obstetric doctor review at booking but declined? You can change your mind.

The BRAIN decision making tool is a great way to help you make the decisions that feel right for you. Find out how to use the BRAIN tool here!

You are allowed to change your mind.

Understanding Your Risk Label in Pregnancy

You will be given a ‘low’ or ‘high’ risk label depending on your medical, pregnancy and social history, but also on factors such as your age and BMI. This label will influence what you are offered during pregnancy and may mean you are discouraged for making certain choices, particularly around place of birth. The main issue with risk labels is that they often lack nuance and you may be viewed as a sum of your risk factors, rather than as an individual.

What Does "High Risk" in Pregnancy Actually Mean?

For example, if you have a BMI over 30 (but no health or pregnancy concerns) you are automatically classified as ‘high risk’ and you will be routinely offered testing for gestational diabetes at 28 weeks of pregnancy. The result of this testing may then influence and impact your options for birth. Why is this a problem I hear you thinking?! Well, just because things are routinely offered during pregnancy does not mean that they’re based on good evidence or that they’re improving outcomes for women and babies. In the case of gestational diabetes, if you are diagnosed with this during pregnancy you will face pressure to accept an induction of labour before 40 weeks. This is despite the fact that there isn't the evidence to suggest that induction of labour is beneficial to women with gestational diabetes.

There are many standardised care pathways within the maternity system and it’s useful to remember that these are based on guidelines (which are not always based on good evidence!) and that they are not the law.

You have the right to question, accept or decline all or certain aspects of care and choose what feels right for you.

If you do opt for care that is ‘out of guidance’ (this means care that is not recommended by national guidelines or the hospital’s own policy), it may be worth contacting the Consultant Midwife at the hospital to help you navigate your choices. You can always seek a second opinion from independent midwives, many of us offer birth planning sessions in addition to full midwifery continuity of care.

You Know Your Body Best: Advocating for Yourself in Pregnancy

You know your body. Pregnancy is the time to really try and tune in and connect with both the physical sensations and changes that are occurring and with your intuition. It can be easy to hand over responsibility to the ‘experts’ and ‘go with the flow’ from when you have your booking appointment, but the reality of doing this is that you will not receive care that is individualised to you. You are an autonomous human being, capable of making decisions during this huge life experience. It can absolutely be useful having the input of a healthcare professional, but ultimately you have to make the decisions that feel right for you and you should never be pressured into accepting something that doesn’t feel right, just because you tick a certain box.

Looking for Personalised Pregnancy Care in Kent?

If you're looking for pregnancy care that sees you as an individual, that supports you to develop self-trust and have a positive pregnancy experience, get in touch today to book your free initial consultation. We offer full continuity of midwifery care, home birth services, birth planning and birth reflections services - find all our care packages here.