Maternity

• Making your first appointment - how to be referred
• Before your first appointment
• At your first appointment
• Choices of antenatal care
• What to expect from your antenatal care

Making your first appointment - how to be referred

When you first find out that you are pregnant you should register for antenatal care as soon as possible. This enables us to organise maternity care for you that takes into account all your needs and preferences.

There are currently three ways that you can be referred to Barts Health maternity services. You can:

• go to your GP or community midwife who will complete a referral for you and send it to us
• completing the Royal London Hospital Royal London Hospital Referral Form
• completing the Newham Hospital Referral Form
• completing the Barking Birth Centre Referral Form 
• completing the Whipps Cross Referral Form
• call the Newham maternity helpline on 020 8090 9999 who will take your details over the phone (for Newham University Hospital only)

Once your referral has been received a booking appointment with a midwife will be sent out to you and ideally be completed before the week 10 of your pregnancy.

At this appointment your individual plan of care will be discussed with you and plans made for your future appointments.

If you have booked to have your baby at another unit but wish to transfer your care to us, please complete the self-referral form above. We will do our best to see you within two weeks of receiving your form.

The Trust offers an interpreting service, Bilingual Health Advocacy Service which includes face-to-face interpreting and also telephone line interpreting. For more information visit the interpreting service pages of our website here.

If English is not your first language and you require this service then this should be included on the referral form and an interpreter will be arranged for your appointment. We prefer not to use any friends or family members to interpret for you.

Before your first appointment

With your appointment letter we will also send a booklet called screening tests for you and your baby. Please read this before your appointment. You will then be able to ask any questions with the midwife before deciding which screening tests you wish to have. 

Please bring with you to your appointment:

• scan reports if you have already had any ultrasound scans
• a copy of your maternity notes, blood results or ultrasound scan reports if you are transferring your care from another hospital

We provide additional services for patients with learning disabilities by giving them a hospital passport. For more information about the passport visit the patients with disabilities page here.

At your first appointment

Your first pregnancy appointment, also known as your booking appointment, will either take place at one of our hospitals or in your local GP surgery or Children’s Centre.

At this appointment the midwife will ask you a series of questions about your medical history, previous pregnancies and health and well-being. The midwife will give you information for your pregnancy, including information about:

• maintaining a healthy pregnancy such as how to eat healthily and stop smoking
• what choices are available to you during your pregnancy, including screening tests and where to have you baby
• how to access antenatal classes

Your booking appointment usually takes around one hour and is also an opportunity for you to ask any questions you may have. You are welcome to have your husband, partner, mother, or friend attend with you.

You will be given your handheld maternity folder which includes your green maternity notes. You should keep these maternity notes in a safe place and bring them with you to every appointment and hospital attendance.

Choices of antenatal care

At your first appointment the midwife will help arrange the best antenatal care package for you and your pregnancy. The midwife will work with you to assess whether your pregnancy has any special considerations called risk factors. This enables us to offer the best care package for you and your baby. 

Midwifery led care

This package is designed for women with uncomplicated, ‘low risk’ pregnancies. Women are booked with a team of community midwives. Antenatal care is provided by these teams in community clinics at Health Centres / Children’s Centres / GP surgeries. Scans are at the hospital. You will only need to see an obstetrician if any problems arise during your pregnancy, or if you or your midwife have any concerns.

Shared care between midwife and GP

This package is also designed for women with uncomplicated, ‘low risk’ pregnancies. The midwife will generally be your lead professional and an agreed schedule of care will be planned. Care is provided with input from your GP. You will go to hospital for scans. You will only need to see an obstetrician if any problems arise during your pregnancy, or if you, your midwife or your GP have any concerns.

Consultant led shared care

This package is designed for women with complicated or ‘high risk’ pregnancies.  Depending on the specific risk factors, your care is led by a named obstetrician and your appointments will be either with the obstetrician at the hospital or with your GP / midwife in the community. Scans take place at the hospital. 

What to expect from your antenatal care

You will be invited to attend regular appointments throughout your pregnancy in order to monitor the health and wellbeing of you and your baby. 

Some of the things you should expect at these appointments include:

• checking your urine and blood pressure
• feeling your tummy to assess the growth and position of your baby
• listening to you baby’s heartbeat (from 24 weeks)

You should use these appointments to discuss any concerns or worries that you may have.

To find out more visit about antenatal care, visit the NHS Choices website here.

The table below outlines your likely schedule of care if you have an uncomplicated pregnancy, this includes 10 appointments for women having their first baby and seven appointments for subsequent births. 

If you have any existing medical problems, or develop complications during pregnancy, you may need to be seen more often.

Schedule of care

Weeks' pregnant	Who you will see	Mother and baby checks
10 - 12 weeks	Community midwife	Booking visit, meet your  midwife and take your history, check BP and urine
11 - 13 weeks	Hospital	Scan and blood test Nuchal translucency scan: measures fluid under skin at back of baby’s neck (a test for Down’s syndrome)
16 weeks	Community GP / midwife	Antenatal check of mother and baby
20 - 23 weeks	Hospital	Anomaly scan: detailed scan for fetal wellbeing
25 weeks	Community GP / midwife	Antenatal check of mother and baby
28 weeks	Community midwife	Antenatal check of mother and baby, blood tests and anti-D if rhesus negative
31 weeks	Community GP / midwife	Antenatal check of mother and baby
34 weeks	Community midwife	Antenatal check of mother and baby, anti-D if rhesus negative, birth plan
36 weeks	Community GP / midwife	Antenatal check of mother and baby, discuss test results and baby’s position
38 weeks	Community GP / midwife	Antenatal check of mother and baby, discuss options if you go beyond 40 weeks
40 weeks	Community GP / midwife	Antenatal check of mother and baby, discuss options if you go beyond 40 weeks
41 weeks	Community midwife	Antenatal check of mother and baby, membrane sweep and book induction

At the end of each your appointments, we will give you details of where and when your next appointment will be and with who. If this is not possible, you will be contacted by telephone or letter with the details of your next appointment.

If you have either missed or not been told about an appointment that you think you should have had, please contact your midwife or antenatal clinic as soon as possible.

During your pregnancy, you'll be offered a range of screening tests, including blood tests and ultrasound baby scans. These tests are designed to:

• help make your pregnancy safer
• check and assess the development and wellbeing of you and your baby
• screen for particular conditions

You don't have to have any of the tests, however, it is important to understand the purpose of all tests is so that you can make informed decisions.

You will be given written information about the screening tests offered. 

Please discuss the tests and ask any questions that you have with your maternity team.

The main screening tests that we will offer you during your pregnancy are listed below:

• 10-12 weeks
• 11-13 weeks dating scan
• 18-20+6 weeks anomaly scan
• Additional tests

10-12 weeks

During your first appointment with your midwife you will be offered blood tests for the following:

• your blood group
• your haemoglobin (iron) level
• abnormalities of the red blood cells (sickle cell diseases or thalassaemia)
• your immunity to German measles (Rubella)
• whether you have syphilis or hepatitis B
• whether you have HIV
• your blood sugar

11-13 weeks dating scan

You will be offered a scan to accurately determine when your baby is due.

This will help us assess that your baby is growing as he/she should be during your pregnancy and will also help you to plan for the arrival. 

11-13 weeks nuchal translucency scan and blood test (combined test)

At your dating scan, you will also be offered a nuchal translucency (NT) scan. The measurement of a fold on your baby’s neck during your scan is combined with a blood test to estimates the risk of your baby having Down's syndrome.

Full support is given to you and your family if your risk is determined to be higher than average.

18-20+6 weeks anomaly scan

You will be offered a further scan to check your baby’s growth and to look for signs of any abnormalities. We may offer further investigations and closer monitoring if abnormalities are present and we will continue to support you throughout.

Additional tests

In addition to the above, you may be offered additional screening tests if your midwife or doctor believes they will help them to monitor the health and wellbeing of your baby.

In our maternity assessment units we provide care for women who need additional monitoring during pregnancy. The name of the unit varies slightly on each of our sites, but the functions are essentially the same.

Women may be referred by their midwife, GP or obstetrician if they need extra monitoring during a complex pregnancy or if there are any concerns. Women can also refer themselves by phoning the unit on the number below.

The maternity assessment unit accepts women who are more than 20 weeks pregnant and who have symptoms such as:

• abdominal pain
• severe itching
• reduced movements
• high-blood pressure
• waters broken (without contractions)

Women will first be assessed by a midwife in the unit, and then may be reviewed by the obstetric team if required.

The availability of our maternity day assessment facilities enables us to support women with pregnancy complications to try to avoid hospital admission until the time of labour.

Do not forget to bring your maternity notes if you come to the maternity assessment unit. Please be aware there may sometimes be a wait as women will be seen on a priority of care basis.

Maternity triage

The maternity triage areas are open 24/7 and are close to our delivery suites. Maternity triage is staffed by experienced midwives who provide urgent assessment and advice for women who think they are in labour or have any concerns.

Reasons for contacting and/or attending triage include:

• you think you are in labour
• waters broken (with contractions)
• bleeding
• any other concerns when maternity assessment unit is closed

The maternity triage is also supported by our obstetric teams who are available to review women with complications when required.

Do not forget to bring your maternity notes if you come to the maternity assessment unit. Please be aware there may sometimes be a wait as women will be seen on a priority of care basis.

At Barts Health, your welfare is extremely important to us.

For women with more complicated pregnancies, we offer a comprehensive range of specialist antenatal services and clinics.

Our team of experts is multi-disciplinary and includes:

• specialist midwives
• obstetricians
• anaesthetists
• medical doctors
• paediatricians
• health workers
• dieticians

Depending on your needs, you will be referred to the relevant specialist team, which may involve visiting one of the following clinics (the names of the clinics may vary from each centre):

• Fetal medicine team
• Diabetic / endocrine clinic
• Renal clinic
• Hypertension clinic
• Maternal cardiac clinic
• Multiple pregnancy clinic
• Mental health clinic
• High BMI
• Preterm labour clinic
• Vaginal birth after caesarean (VBAC) clinic

Fetal medicine team

Most pregnancies progress without any complications, however, sometimes a mother or her unborn baby needs extra care.

Our Fetal Medicine team is a specialised department that offers women and their families support through pregnancy and antenatal screening when a congenital or genetic condition might be suspected or diagnosed. The Fetal Medicine team also provide specialist scanning and support for women with complex pregnancies such as with twins or triplets.

During what can be a very stressful and difficult time, we strive to provide continuity for women and their families to make the process as smooth as possible. We are available to discuss screening options and results and support women to make decisions that are sympathetic to their family's values and beliefs.

Our support may include:

• advice and/or counselling to aid decision making
• working closely with our clinical genetics team to ensure that women and their partners receive all  the information they require
• helping women through diagnostic procedures such as amniocentesis or chorionic villus sampling
• signposting women and their families to other resources of advice and support
• making referrals to other hospitals that specialise in specific conditions for further assessment

Fetal medicine clinic

If you are referred to this clinic, you will have a detailed consultation where we assess the potential problem and plan your care.

We also perform a detailed (level 3) assessment of the baby’s fetal anatomy using the latest ultrasound equipment. We can offer further investigations including invasive diagnostic and therapeutic procedures where appropriate.

Fetal echocardiography clinic

Our combined fetal echocardiography clinic is for women with congenital heart conditions, a family history of congenital heart conditions or where the baby is found to have a heart condition. Women can be referred to this clinic by either their Midwife or Obstetrician. Some women will also have shared care with Great Ormond Street Hospital (GOSH) cardiology team.

Diabetic / endocrine clinic

This weekly clinic is for women with an existing endocrine problem or diabetes. There is a comprehensive diabetes service and an anaesthetic review service. 

The clinic is staffed by a multidisciplinary team including:

• consultant obstetricians
• specialist midwife/coordinator
• consultant endocrinologist (diabetes specialist)
• diabetes specialist nurses
• specialist dietician

The team works together to ensure each woman receives an individual plan of treatment and care.

Renal clinic

This is a clinic for women who have had kidney transplants in the past or have known kidney problems. After a joint review by an obstetrician and specialist renal consultant, a plan of treatment and care will be agreed.

Hypertension clinic

If you suffer with high blood pressure, either before or since becoming pregnant, you may be asked to attend this weekly clinic. A plan of treatment and care will be devised by an obstetrician and a medical consultant.

Maternal cardiac clinic

This is a clinic for women with heart transplants or known heart problems. Your specific condition will be reviewed and a plan of treatment and care made jointly by an obstetrician and consultant cardiologist.

Multiple pregnancy clinic

Multiple pregnancies are an exciting time for both parents and doctors. They do, however, bring additional complexities to pregnancy which is why women with multiple pregnancies receive a dedicated and unique multidisciplinary multiple pregnancy service. 

If you are referred to this clinic, you will be seen by a dedicated team of consultants, sonographers, and fetal medicine midwives. Some women will have all their antenatal care at hospital, while others will have a shared care schedule with the community midwives.

Mental health clinic

This is a clinic for women with a history of significant mental health problems. The service is run by a consultant obstetrician and specialist midwife, a consultant psychiatrist and two psychiatric nurses.

Haematology thrombophilia clinic / antibody clinic

These clinics are for women with a history (or history in their family) of blood clotting problems or abnormal antibodies. After review by an obstetrician and a consultant haematologist a plan of treatment and care will be agreed.

High BMI clinic

This is a clinic for women with a Body Mass Index (BMI) of 35 or more. The BMI is calculated by height and weight and a figure of 35 is deemed to be obese and may pose a substantial risk in pregnancy. 

The clinic is staffed by a consultant obstetrician, an anaesthetist and a midwife. Each woman will be assessed and assigned a plan of care.

Preterm labour clinic

This is a clinic staffed by a consultant obstetrician for women who have a history of delivering their babies prematurely. An individualised plan of care will be made and midwives and obstetricians assigned to monitor each pregnancy.

Vaginal birth after caesarean (VBAC) clinic

This is a clinic for women who have had at least one previous caesarean section. The reasons for the previous caesarean section(s) will be reviewed and discussed with each woman, together with the birth options for the current pregnancy. The clinic is staffed by a senior midwife who will discuss how to maximise the chances of a vaginal birth in the current pregnancy. Women requesting a repeat caesarean section will be referred to the obstetric team for further planning.

Antenatal classes are a useful way for you and your support partner to understand what to expect during labour and birth, and how to prepare to look after your new baby. Classes are informative, friendly and fun. We offer a range of classes at different times, including intensive one or two day classes.

It is also an opportunity to ask a midwife any questions that you may have. The classes are also an excellent way for you to meet and get to know other expectant parents in your area.

Demand for classes is high, so please book as early as possible.

Topics usually covered in the classes include:

• Recognising the signs of labour and what to do
• Breathing and relaxation for labour and birth
• Natural and medical pain relief options
• Complicated births and interventions
• Breast feeding
• Caring for a newborn

In some areas we also offer specialist classes for:

• Twin pregnancies
• Bengali speaking women
• Dads only
• Active birth

Contact the antenatal education team at your hospital to find out more.

Physiotherapy during pregnancy

There is a specialist team of obstetric physiotherapists who offer treatment for pregnancy-related problems such as back pain and carpal tunnel syndrome (pain and aching, numbness or weakness in the fingers). Please speak to your midwife if you would like to be referred to this service.

Stop smoking service

This service provides support and advise (one-to-one or group sessions) to help pregnant women give up smoking. We also provide help and advice on using nicotine replacement products. Please speak to your midwife if you would like to be referred to this service, or call 080 0169 1943 (freephone). 

Newham antenatal classes and workshops for mums and dads-to-be

The Newham Parent Education Team provides a wide range of antenatal classes and workshops for expectant mums and birth partners. We would like you to get as much benefit as possible from our tailor made services. Our classes are informative, fun, interactive and will prepare you for birth and beyond.

These courses will be offered free to all Barts Health women and your birth partners if you are receiving care at Newham Hospital, Community Midwifery Practices or the Barking Community Birth Centre.

There is a high demand for antenatal classes, spaces are limited so please book early from 24 weeks. Please telephone or email your requests.

Phone: 0207 363 8026
E-mail: newhamparenteducationteam@bartshealth.nhs.uk

• Antenatal Classes: Are five week evening classes or two day intensive courses. These sessions include stages of labour, relaxation, pain relief, caring for your new baby, life as new parents and more!
• Waterbirth Workshops: Discover how labouring or giving birth in water enables you to have a gentle birth.
• Relax for Birth Sessions: Learn how relaxation empowers you for labour and birth.
• Maternity Unit Tours including Barking Community Birth Centre
• Dadi Antenatal Day: A uniquely designed Antenatal class for expectant fathers to become empowered to support their partners during labour and beyond.
• Breastfeeding Workshops: These workshops are definitely for you if you are considering breastfeeding or want to learn more about infant feeding. Breastfeeding Groups are for antenatal and postnatal women.

After your birth you will continue to receive care from our experienced team of midwives and maternity care assistants on one of our postnatal wards or in our birth centres.

Getting to know your baby and building a close relationship is important and will be supported by staff. Ask for help with skin-to-skin contact, safe sleeping and responsive feeding.

A midwife or care assistant will offer to help you to start breastfeeding in the first hour after your baby is born. Your baby will be kept with you at all times and will be in a cot beside your bed. All staff are trained to help you with your baby.

Further information on the care and support available after you have had your baby is available below:

• feeding your baby
• going home
• transitional care / neonatal unit
• neonatal intensive care unit
• newborn hearing and screening tests
• community midwifery services
• breast feeding support
• Health Visiting team
• Children’s Centres
• Whipps Cross discharge video

Feeding your baby

If you decide to breastfeed you will be shown how to hold your baby and how to help them latch on – this will make sure they get enough milk and that feeding is not painful. You will be given advice about how to breastfeed and how to make enough milk for your baby. Staff will offer to show you how to express your milk by hand. Your baby will not be given water or formula milk unless there is a medical reason.

You will receive information about the support available for breastfeeding once you leave hospital. Make sure you have the information leaflet before you leave.
If you decide to bottle feed, staff will support you. They will ask if you want to be taught to make formula feeds and will give you information on formula feeding.

 

Going home

When you are ready to go home may vary depending on the type of birth you have had and whether there are any complications for you or your baby. If you have a normal birth and you and your baby are well, you will be able to go home quickly about 6 – 8 hours after the birth. If you need to stay longer you can discuss this with your midwife who will keep you informed of your care plan. Before you leave the midwife will give you a discharge pack and explain this to you. It includes a variety of information that you may find useful including how to register your baby.

Transitional care / Neonatal Unit

Sometime babies require extra care and treatment following the birth. This may include extra observations to ensure they are not becoming ill, monitoring of their blood sugar levels if you have Diabetes or they may need treatment to prevent or treat infections and jaundice. Most of this care can be given with the baby by your bedside in Transitional care which is part of the postnatal ward. Babies may stay from just a few hours to five days in Transitional care. The care is providing by midwives, specialist nursery nurses and healthcare assistants to support you and your baby during this time.

Neonatal Intensive Care Unit

When a baby is born very early or requires specialist support for breathing or other specialist care, the baby will be admitted to the Neonatal Intensive Care Unit. If your baby is admitted here you will be able to visit as often as you want and help care for your baby. Your baby may need to stay for a long period and if you live far away accommodation may be available locally for you. Staff will give you information and support so that you can express your breastmilk for your baby if not yet breastfeeding.

Newborn examination and screening tests

After your baby is born the midwife will carry out some initial checks to make sure your baby seems healthy. A more detailed physical examination, within 72 hours of the birth, will be performed by a specially trained midwife or doctor. This can help identify health concerns at an early stage and identify babies more likely to have conditions that need investigation. Most babies who have the physical exam are healthy and most problems are minor and do not need significant treatment.

For the small number of babies who have serious problems, there are a lot of benefits of having these identified as soon as possible. Early treatment can improve the health of the baby and prevent disability.

Hearing screening is offered to all newborn babies. This is important as one to two babies in every 1000 are born with a hearing loss in one or both ears. Early identification is known to be important for the development of your child. Hearing screening will either be performed while you are in hospital, or an appointment will be arranged for your baby to attend a clinic after you have gone home. Information on hearing screening can be found at: www.hearing.screening.nhs.uk

Newborn blood spot screening is offered to all newborn babies and is performed between five to seven days of age. This blood test is performed to identify babies who may have rare but serious conditions. Early treatment can improve their health and prevent disability. Information on blood spot screening can be found at:  www.newbornbloodspot.screening.nhs.uk

Community midwifery services

When you are leaving the hospital it is important that the midwife has correct details of your address and telephone numbers. The discharging midwife will inform the community midwifery teams where you live that you are home.  Please make sure you inform the midwife if you will be staying at a different address temporarily.

After you go home (or after a home birth) you will receive care and support from your local community midwifery team. The midwives will check both you and your baby to ensure that you are healing after the birth, that your baby is feeding well and give you advice during the early days with your baby. They will visit you at home in the first instance, then some of your follow up care will usually be a Postnatal clinic. The postnatal clinics are held at children’s centres / birth centres / group practices and a midwife will see you and your baby there at an agreed time.

If you have not been contacted by a midwife after being home for 24 hours please contact the community midwifery team for your area.

For The Royal London

Community secretary: 020 3594 2557 
Monday to Friday, 9am-5pm (Answerphone also available for messages). 
At weekends or out of hours contact the Delivery Suite: 020 3594 2364

For Newham

Newham maternity helpline: 020 8090 9999 
Monday to Sunday, 10am – 8pm

For Whipps Cross

Community secretary: 020 8539 5522 ext. 4692. 
Monday to Friday 9am-5pm (Answerphone also available for messages)

Breast feeding support

What happens in your baby’s first year has a big effect on how healthy he or she will be in the future. Mum’s milk gives your baby all the nutrients they need and getting help and support with breastfeeding is a good idea for all new mothers not just for those having difficulties.  You will receive information about the support available in your area for breastfeeding when you leave hospital. Ask your midwife and health visitor for information leaflets on local breastfeeding groups.

Some of support groups and services available in our local area include:

Tower Hamlet Breastfeeding Support

This group provides support on antenatal and postnatal care. These services are fully accredited by the UNICEF Baby Friendly Initiative. This worldwide standard recognises work which supports, promotes and protects breastfeeding. Drop in groups are held at children’s centres and Barkantine Birth Centre.

If you have any questions or concerns about breastfeeding at any stage, or would like a home visit (usually for babies under one month) please call or text the team. 079 6160 9626 or 020 3594 2591 and leave a message Monday to Friday.

Newham Breastfeeding Drop-in Groups

A drop-in group for antenatal and postnatal advice and support. These services are working towards UNICEF Baby Friendly Initiative accreditation and all children’s centres are breastfeeding friendly. Ask your midwife for an information leaflet.

Call Yohana Wade on 020 3373 0286 Monday to Friday 9am–5pm for information on group times only.

Redbridge Infant Feeding Team

A team whom provide for antenatal and postnatal advice and support. These services are working towards UNICEF Baby Friendly Initiative accreditation and all children’s centres are breastfeeding friendly. Breastfeeding Café’s open across the area ask your midwife for an information flyer or call the team.

Contact the team from Monday to Friday 9am-5pm on: 020 8822 4157 or by text: 077 0291 9345 or email: nem-tr.infantfeedingteam@nhs.net.

Waltham Forest children's centres

All children’s centres are breastfeeding friendly and ask your midwife for information on local groups and café’s.

If you need information or support with breastfeeding in the evenings or at weekends please call:

National Breastfeeding Helpline: 030 0100 0212
BfN Support in Bengali/Sylheti: 0300 456 2421
Open from 9.30am - 9.30pm 365 days a year.

Health Visiting Team

The midwives will hand over the care of you and your baby to the Health visiting team around 2 weeks after your baby’s birth. Your health visitor will contact and visit you at home, usually between 10 and 14 days after your baby was born. You will then be able to attend a local baby clinic. The health visitor will provide advice and support in your baby’s early months and years about your baby’s development, eating, sleeping, immunisations and much more. Ask you health visitor for information on your local children’s centres and other parenting groups.

Find out more aout our dedicated Heath Visiting Service here.

Children’s Centres

Children’s centres offer a wide range of services, activities and support for children aged 0-5 years and their families. Find out about your local Children’s centres and the groups and services they provide.

• Tower Hamlets Children’s Centres 
• Newham Children’s Centres
• Waltham Forest Children’s Centres
• Redbridge Children’s Centres
• Barking and Dagenham Children’s Centres

Whipps Cross discharge video

If you have delivered your baby at Whipps Cross, watch this discharge video for useful information about caring for your baby once you have taken them home. You will have also been given a discharge booklet by the Whipps Cross maternity team which gives additional information.