Pregnancy care, from booking to delivery

When should I book my first antenatal appointment?

As soon as you know you are pregnant, and ideally before eight weeks. The first appointment sets the dates, confirms the pregnancy is in the right place, and works out which kind of care suits you. Booking early matters more than most people expect, because several of the screening tests can only be done inside a particular window, and a late booking closes some of those doors for good.

If you have a medical condition, take regular medication, or have had a difficult pregnancy before, say so when you book rather than waiting for the appointment. Some things are better adjusted before the pregnancy is far along.

Before eight weeks if you can. Say at booking if you take regular medication.

What happens at antenatal appointments?

The first is long and mostly talking: your history, previous pregnancies, illnesses, operations, medication, and what is normal for you. After that the visits are shorter and follow a rhythm. Blood pressure, urine, the baby growing at the rate it should, and the questions that have come up since last time. Scans happen at set points rather than at every visit. The pattern gets closer together towards the end.

How often you are seen depends on the pregnancy. A straightforward one is seen less often than one that needs watching, and that can change in either direction as things go along.

Every visit

Blood pressure, urine, growth, and anything you want to raise.

At set points

Scans, blood tests, and any screening you have chosen.

Towards the end

Visits get closer together, and the plan for birth is agreed.

Which scans are done during pregnancy?

An early scan confirms the pregnancy is inside the womb and gives the due date, which the first scan dates more accurately than any later one. Around eleven to fourteen weeks there is a scan that looks at the back of the neck and can be combined with blood tests. Around twenty weeks a longer scan goes through the anatomy in detail. After that, growth scans are done when there is a reason to do them.

A scan is a look, not a verdict. Most of what it shows is reassuring, some of it needs another look a fortnight later, and occasionally it finds something that changes the plan. You are told what is being looked at before it starts.

The usual pattern. Which of these you have depends on your pregnancy, and Dr Bheena Vyjhallaja will say which apply to you.

What is NIPT, and do I need it?

NIPT is a blood test from the mother that looks at fragments of the baby’s DNA circulating in her blood. It screens for a small number of chromosomal conditions, chiefly Down syndrome. It is a screening test, not a diagnosis: it tells you whether the chance is high or low, and a high result is followed by a diagnostic test before anything is concluded. Nobody needs it. It is offered, explained, and entirely your decision.

It is worth deciding in advance what you would do with the answer, because that is the question the result puts in front of you. Some people want to know whatever there is to know. Some would rather not, and that is a legitimate position and not one that gets argued with here.

A screening test, not a diagnosis. Declining it is a normal choice.

What makes a pregnancy high risk?

Usually one of a few things: a medical condition that was there before, such as diabetes, high blood pressure or a thyroid problem; something that develops during the pregnancy, such as raised blood pressure or gestational diabetes; carrying twins; or a difficulty in a previous pregnancy. The phrase sounds more alarming than it usually is. It mostly means being seen more often and watched more closely, not that something is going wrong.

Dr Bheena Vyjhallaja’s specialist training in the United Kingdom carries a good deal of complex obstetrics, so a pregnancy that needs closer watching is familiar ground rather than something to be referred onwards.

How her training was done

Where will my scans and delivery take place?

Both at KPJ Damansara Specialist Hospital in Petaling Jaya, where she consults. Scans are done in clinic during your appointment rather than sending you elsewhere and asking you to come back with a report. Delivery is at the same hospital, which means the people looking after you in labour are working from the notes of someone who has seen you throughout rather than reading you cold.

Knowing the building before you arrive in labour is worth more than it sounds. By the time you deliver you will have walked in and out of it a dozen times.

Can I say how I want to give birth?

Yes, and it is a conversation worth having before you are in labour rather than during it. What you want, what you are worried about, pain relief, who is with you, and what you would prefer if things need to change. A plan is not a promise that labour will follow it. It is a record of what matters to you, so that decisions made quickly are still made in the direction you would have chosen.

Some of it will be settled by circumstance on the day. The parts that can be your choice stay your choice, and you will be told what is happening while it is happening rather than afterwards.

What should I bring to a first pregnancy appointment?

Anything you already have. Previous scan reports, blood results, discharge summaries from an earlier delivery, and a list of any medication you take, including things bought without a prescription. If you have been under another doctor for this pregnancy, bring what they gave you. Repeating a test that has already been done wastes an appointment, and an old set of notes often answers a question faster than a new test would.

Old notes, scan reports, and a list of your medication.

Clinic hours and how to book