Antenatal Care: How Does Regular Monitoring Work Throughout Pregnancy, and Which Check-Ups Are Done?

Antenatal care is the regular monitoring of your health and your baby's health by a doctor or midwife throughout pregnancy, the carrying out of the necessary measurements and screening tests, and the giving of information and support to you. Current antenatal care recommendations address this care not only to prevent problems but also so that you have a positive pregnancy experience. In Turkey, the timing and frequency of monitoring are planned according to the Ministry of Health's antenatal care programme and the risk status of your pregnancy. The timing and scope of tests and ultrasound vary from person to person; the details are planned by the doctor or midwife who follows you.

Why is antenatal care important?

The aim of regular monitoring is to observe your health and your baby's health throughout pregnancy, to notice problems that may arise early, and to provide you with information and support. Current recommendations emphasise that care should be person-centred; that is, your questions, concerns and preferences are part of the care. A model that is respectful, person-centred and involves several consultations is recommended; increasing the number of consultations is recommended in order to reduce baby loss in the perinatal period and to improve the experience of care. For the schedule applied in Turkey, the plan of the doctor or midwife who follows you is the basis. Feeling well does not mean that monitoring is unnecessary; the health professional who follows you decides the frequency of check-ups.

Who provides antenatal care?

Antenatal care is carried out by a doctor, midwife or nurse, depending on the person and on how the health system works. Which health professional carries out which consultation varies with your situation and with the arrangement of the health institution you attend. It may not be possible to see the same person throughout pregnancy; in this case, having your earlier results and the questions you have noted with you makes the flow of information easier.

What is assessed at the first visit?

At the first visit after the pregnancy is noticed, a health history is taken and the necessary examinations and investigations are planned. In the Ministry of Health's antenatal care programme in Turkey, the person's risk status regarding pregnancy is assessed at the first monitoring visit and the monitoring plan is determined accordingly. If you conceived with assisted reproduction treatment, the timing of early monitoring is discussed separately with the doctor carrying out the treatment.

What is done at regular check-ups?

Regular check-ups cover assessment of the mother and baby (such as blood pressure, blood and urine tests, and fetal measurements); your complaints are also asked about at check-up consultations. Which assessments are done varies with the health system and the person. The consultations are also an opportunity for you to ask your questions and to get information on diet and lifestyle.

Why might your check-up schedule differ from another pregnant woman's?

How many times and at which times check-ups are done is not tied to a single schedule; there are different approaches between sources and countries. In Turkey, timing and frequency are planned by the doctor or midwife according to the Ministry of Health's programme. If a risk is found in pregnancy or arises later, the monitoring plan can change. For this reason your schedule may differ from another pregnant woman's. It is important to follow the schedule when it is given to you, and when you notice a change, to seek care without waiting for the appointment day.

Which subjects are covered during monitoring?

The scope of antenatal care is kept wide: diet and supplements, physical activity, tobacco, alcohol and substance use, blood tests and tetanus vaccination, fetal measurements (including early ultrasound), common complaints such as nausea, back pain and constipation, partner violence and the prevention of some infectious diseases are counted among these subjects. Which heading is covered when varies from person to person.

How are blood tests, ultrasound and screening planned?

Blood tests, ultrasound and some screening tests may be planned throughout pregnancy; blood tests and fetal measurements including early ultrasound are among the recommended care. Which test is done in which period, what it shows and does not show, and its limits vary with the type of test and your situation. The doctor or midwife who follows you plans their timing and scope; test results have limits and the results must be interpreted together with the health professional.

How are vaccines and protection from infectious diseases discussed?

Which vaccines and preventive practices are suitable in pregnancy is determined together with your doctor. Tetanus vaccination and the prevention of some infectious diseases are also among the recommended care. Consult your doctor rather than deciding on your own whether to have or avoid a vaccine.

Whom can you consult about diet, supplements and activity?

Diet, supplements and physical activity are also counted among the subjects of care. Which foods, vitamins or types of exercise are suitable for you varies with your state of health. Instead of applying supplements of unclear origin, herbal products or general lists of banned foods on your own, ask your doctor or midwife about every product you want to use.

Can you get support if you use tobacco, alcohol or substances?

Tobacco, alcohol and other substance use are also counted among the subjects of care. For people who use them, support for quitting can be planned by consulting the health professional.

What can you do if you have nausea, back pain or constipation?

Common complaints such as nausea, back pain and constipation are also counted among the subjects of care. For these complaints your doctor or midwife can recommend measures that give relief. Rather than deciding yourself whether a complaint is usual, ask your health professional.

Can you share concerns about your mental health or safety?

Pregnancy can be an emotionally demanding period. You can share feelings such as sadness, anxiety or thoughts of harming yourself or your baby with your health professional; thoughts of harm are counted among the signs of an emergency. Partner violence is also among the subjects recommended to be addressed in care. If you have a concern about your safety, you can talk about it with your health professional.

What is a high-risk pregnancy?

A high-risk pregnancy is a general concept describing situations that may require more than average attention and closer monitoring for the mother or the baby. Factors such as a pre-existing illness, problems in earlier pregnancies, a condition that arises during pregnancy or a multiple pregnancy can change the risk. The expression high-risk pregnancy is not a judgement; it means that monitoring is planned accordingly.

In the Ministry of Health's antenatal care programme in Turkey, the monitoring plan in high-risk pregnancies is determined according to the risk; your risk status is reassessed throughout monitoring, and if a new factor appears as pregnancy advances, the monitoring plan can change. To learn whether you have a risk factor, you can ask your doctor or midwife.

What should you do if the baby's movements decrease or you notice other changes?

In the list of emergency warning signs prepared for pregnancy and the year after birth, the baby's movements stopping or decreasing are included. If you notice a decrease or stopping in your baby's movements, tell your health professional without delay; do not wait for the movements to recover on their own. The same list also includes signs such as a headache that does not go away with painkillers, a sudden change in vision, sudden marked swelling of the hands or face, swelling or pain in one calf, shortness of breath and chest pain.

When is preparation for birth discussed in monitoring?

As pregnancy advances, preparation for birth enters the subjects of monitoring. Decisions such as where and how the birth will take place are discussed with the doctor or midwife according to the course of the pregnancy.

Can you take part in decisions and bring someone close to you to the consultation?

Current recommendations treat care with a person-centred approach; your questions, concerns and preferences are part of the care. In person-centred care you are expected to be informed about the tests and practices done, to ask questions and to take part in decisions. If you wish, you can ask for someone close to you or someone you trust to accompany you to consultations; the presence of a partner is not necessary, and people carrying a pregnancy on their own benefit from antenatal care in the same way. Do not hesitate to ask your health professional to explain a term or practice you do not understand.

How can you prepare for the check-up, and what can you ask your doctor or midwife?

• Take with you the list of medicines and supplements you use, your chronic illnesses and your information on earlier pregnancies or births.
• Keep your earlier test and ultrasound results and bring them to every consultation.
• Write down what you want to ask before the consultation.
• Who will do my monitoring, and how often is it planned?
• Which tests and ultrasounds are being considered for me, and when?
• Do I have a risk factor, and if so how does my monitoring change?
• Are the medicines and supplements I use suitable in pregnancy, and which vaccines are considered?
• If I have a problem, whom can I call, by what route and at what hours?