Who leads your maternity care in the UK: midwife, GP or consultant

The midwife is the default, not the consolation prize

In the UK, antenatal care is the care you get from health professionals during pregnancy, and the NHS describes it in one line: you will usually see a midwife, and also a doctor if you need to. That is the whole model. A midwife leads care for most pregnancies, and medical staff are brought in for the pregnancies that need them.

This surprises people who have moved from systems where an obstetrician leads every pregnancy. It is not a downgrade. Midwives in the UK are autonomous registered professionals who carry clinical responsibility for normal pregnancy and birth, and the escalation route to an obstetrician is built into the pathway rather than bolted on.

You start your own care

Here is the step people most often get wrong. To start your NHS antenatal care you need to tell NHS maternity services that you are pregnant, and you can do this by referring yourself for NHS pregnancy care as soon as you know you are pregnant. You do not have to wait for a GP appointment to be allowed into the system.

If you have referred yourself and have not been given an appointment, the NHS advice is to contact local maternity services and ask for one. Do not wait quietly. Booking early is what gets you screening in the right window.

The booking appointment

Your first appointment with a midwife usually happens at 8 to 12 weeks, is called the booking appointment, and can take around an hour. It is a long appointment because it is doing a lot of work at once.

The midwife asks about the date of your last period, previous pregnancies, health conditions, your mental health, exercise, alcohol and smoking, your job, your home situation and your ethnic background. They may also ask questions to check whether they can offer extra support, including about domestic abuse, sexual abuse and female genital mutilation.

They check your blood pressure and test your urine, looking for high blood pressure, pre-eclampsia and urine infections, and offer a blood test to check your blood group. You get your maternity notes, in an app, book, folder or secure website, and you are told to keep them with you at all times so any healthcare staff can read your pregnancy history in an emergency.

How many appointments you actually get

The NHS commits to a specific number. You will be offered at least 10 antenatal appointments if this is your first baby, and 2 ultrasound scans. If you have given birth before, you will have at least 7 appointments, because you usually do not need as many as in a first pregnancy.

Appointments may be in different places: hospitals, GP surgeries or community clinics. Your partner can come if you want them to. And you can contact maternity services at any point if you are worried about your health or your baby's health. You do not have to wait for the next appointment, and this is stated NHS policy rather than a favour.

Where the doctors appear

Obstetricians lead care when there is an obstetric reason to. If your pregnancy is high risk or you have certain medical conditions, the NHS says it is safest to give birth in hospital where specialists are available. Anaesthetists give epidurals. Neonatologists and a special care baby unit exist for babies who need them.

Your GP has a smaller role in pregnancy than in some other countries, but remains your route for non-pregnancy health problems, and children's centres, your GP surgery and local maternity units are all named by the NHS as places to get information about local services.

Continuity of carer

NICE, the body that sets clinical guidance for the NHS, recommends that those responsible for planning and delivering antenatal services should aim to provide continuity of carer: seeing the same midwife or small team through pregnancy rather than a different face each time.

Aim is the operative word. Continuity is a service ambition, delivered unevenly and dependent on local midwife staffing. NHS England's Maternity Transformation Programme has been working on it since Better Births in 2016 and reported that 17.3% of pregnant women were on a continuity pathway in March 2019. If continuity matters to you, ask your local service what model they run rather than assuming.

What we cannot tell you

Whether your area offers caseload midwifery, a community hub, or a named midwife is a local commissioning decision that changes. So is how quickly self-referral turns into a booking appointment. We are not going to publish a national waiting time, because there is not one. Ask the service directly, and chase if nothing arrives within a couple of weeks.

What to ask at your booking appointment

Will I see the same midwife or team? Who do I call out of hours, and is that number in my notes? What are my options for where to give birth locally? What screening am I being offered, and by when do I have to decide? And, if you have a health condition, ask early whether you should be under consultant-led care, because that referral is easier to make at 10 weeks than at 30.

What happens at each appointment

The pattern is consistent from 16 weeks onwards. At almost every appointment the midwife asks about your health and wellbeing, checks your blood pressure, tests your urine, and from 25 weeks measures your bump to check the baby's growth, discusses your baby's movements and asks about your mental health.

Specific things attach to specific weeks. At 11 to 14 weeks you are offered the dating scan, with screening for Down's, Edwards' and Patau's syndromes if you want it. At 18 to 21 weeks you are offered the 20-week screening scan. If you have a higher chance of gestational diabetes, testing is offered between 24 and 28 weeks. At 28 weeks you are offered a blood test and, if your baby is at risk of rhesus disease, an injection. From 34 weeks the conversation turns to preparing for the birth, and from 38 weeks to your choices if you are still pregnant after 40 weeks.