Written by Sophie Martin. Reviewed by Dr Phoebe Howells. 

Sophie Martin has worked in maternity services for the past 13 years, ranging from Central London to being a Lead Midwife for Antenatal Clinic services in Essex. She has a particular focus on supporting parents who face challenging paths to parenthood. Sophie is the author of The Infertile Midwife and is also a Medical Advisor for BabyCentre UK and Emma's Diary. When she's not working, she's busy raising two young children.

Trigger warning: sensitive content relating to pregnancy. 

This blog discusses pregnancy and provides advice for those currently pregnant. We recognise that this may feel sensitive or emotionally challenging while you are trying to conceive. Please take care if you decide to read this, and please stop reading if at any point you feel you need to. 

Your well-being matters, and that is the biggest priority. OVUM is here to create a community that is safe and accessible to all, so we recognise that we need to have boundaries in place to make sure everyone is comfortable when we share information and education. 

Support is available for you, and some resources include: 

• Tommy’s Charity: a charity supporting those through pregnancy and baby loss

• Mind UK: a mental health service available to adults in the UK

• Fertility Network UK Support Groups: available to those who wish to share experiences with others.  

When is the first midwife appointment?

In the UK, you will usually self-refer to a maternity service and can expect to have your first midwife appointment, also called the ‘booking appointment’, around weeks 8 or 9.

This is a very important appointment that usually takes around an hour. It gives you a chance to meet your midwife, learn lots of information about staying healthy in pregnancy, and also for the midwife to get to know you too, so they can plan the best way to support you during pregnancy. 

During the first appointment:

This is a detailed appointment where the midwife will ask you lots of questions. This will include questions about your medical history, your family history, your mental health, your surgical history and any previous pregnancies too. If you have a partner, they are able to attend, but it is not necessary. Although it might seem like a lot of questions, the midwife is using this information as a screening tool to determine the best plan of care for your pregnancy. 

Once the midwife has gathered all the information about you, they will share the appointment schedule, which may include additional appointments depending on your circumstances. This has always been one of my favourite appointments as a midwife, as it is an exciting part of the pregnancy journey! You should have the date for your ’12 week’ or ‘dating scan’, and your next midwife appointment will be around 16-18 weeks.

There is a small physical examination, which includes taking your height and weight, measuring your carbon monoxide levels, checking your blood pressure and urine sample as well as some blood tests. The blood tests are another screening tool, and will check your haemoglobin level, identify your blood group, and check for conditions such as sickle cell and thalassaemia, as well as infectious diseases like HIV, hepatitis B and syphilis.

You will also have the opportunity to ask any questions you have. Don’t be shy here - we know that if you find out you are pregnant at around 4 weeks, it can feel like a long wait to be able to speak to someone. It’s normal to find this appointment overwhelming, especially if this is your first pregnancy, but be reassured that you have many months to prepare yourself for the arrival of your little one(s)!

Why midwives ask about prenatal supplements:

During your booking appointment, the midwife will ask whether you are taking a prenatal supplement. This is because the NHS recommends all people who are pregnant or trying to conceive take 400mcg of Folic Acid and 10mcg of Vitamin D daily, until 12 weeks of pregnancy.

Both of these supplements are incredibly important. In particular, taking Folic Acid prior to pregnancy and during the first 12 weeks can help reduce the chance of your baby having a neural tube condition such as spina bifida. There may be some medical or health conditions, such as diabetes, having a BMI of over 30, or having a history of neural tube defects either in yourself, your family or a previous pregnancy, which mean the midwife recommends you take a higher dose of 5mg. Your GP can prescribe this for you, if it is relevant.

Vitamin D is essential for maintaining healthy bones, as well as supporting teeth, muscle and immune function, all of which are key to maternal and fetal health. Supplementation is recommended because we cannot absorb Vitamin D from the sun year-round in the UK. This is particularly important if you spend a lot of time indoors or have darker skin tones, including those of African, African Caribbean, or South Asian origin. In these instances, the lower exposure to sunlight or higher melanin reduces the skin’s ability to produce Vitamin D from sunlight. 

What I look for in a prenatal:

As already mentioned, Folic Acid and Vitamin D are the bare minimum we want pregnant people to be taking, however a great prenatal supplement will go much further to support your nutrition. During pregnancy, nutritional requirements increase, and meeting these needs through diet alone can be challenging, particularly in the first trimester, when pregnancy nausea and sickness may make it harder to eat a balanced diet.

Other key ingredients I would therefore look out for, which are all included in Ovum’s Time to Carry®, are as follows:

Choline

This lesser-known nutrient is an absolute powerhouse for your baby’s brain. This is often lacking from diets, therefore knowing you can get this from your daily prenatal is reassuring. This is particularly important during the third trimester, when your baby’s brain is gearing up for life on the outside. 

Currently, there is no UK Reference Nutrient Intake set for Choline, however the European Food Safety Authority has suggested that 480mg a day would be adequate for pregnant people. Foods that are rich in Choline include eggs, meat, whole grains, as well as fruit and vegetables. But as 480mg equates to roughly 4 eggs daily, supplementing this nutrient can be particularly beneficial for those suffering from nausea. 

Iron

This helps the development of our red blood cells, which in turn then transport oxygen around the body to all our muscles. Anaemia (having low iron) can be common in pregnancy, therefore it can be helpful to include this in your supplement. This is particularly relevant in the third trimester as you gear up for birth, and also because your blood volume increases. Anaemia is commonly treated with oral Iron, often with 200mg of ferrous sulphate, as a first-line treatment. 

I particularly like that the Time to Carry® supplement has specially selected a form of Iron that goes easy on digestion -  a common side effect of many Iron supplements. You can also support your iron intake by eating red meat, beans, and nuts. Try to avoid drinking tea or coffee alongside Iron supplements, as this can reduce the absorption; however, Vitamin C can increase the absorption.

Folates

As previously mentioned, the NHS recommends Folic Acid as part of its guidance. Folic Acid is therefore included in most prenatal supplements and is a vital supplement for the first trimester, aiming to reduce the risk of neural tube defects such as spina bifida. 

Whilst the NHS recommends Folic Acid, some people will benefit from taking Folate in the form of Methylfolate, which is a biologically active form of Folate. This is because some people have genetic variations in the MTHFR gene, which makes it more difficult for them to process Folic Acid, so the more biologically active Methyfolate bypasses this conversion. 

Iodine

This is recognised by the WHO as an essential nutrient during pregnancy and contributes to normal thyroid and cognitive function. As intake requirements typically increase during pregnancy, I would advise taking this in all trimesters, and a dose of 150mcg is recommended.

How to prepare for your booking appointment:

Come prepared with details of any health conditions, medication you are taking, any previous surgeries you have had, and any relevant letters from other Doctors. It can also be helpful to bring any documentation related to previous pregnancies, particularly if you are now attending a different hospital. From a midwife’s perspective, more is more here! We love having all the information to hand, as it makes our job of working out the next steps much easier.

Come with questions! This is the perfect time to ask your midwife lots of questions - this appointment can contain a lot of information, and we don’t expect you to take it all in, so your midwife should let you know where you can refer back to it. Many hospitals nowadays offer virtual resources you can access from home whenever you need more information.

Be as open as you can during the appointment - the midwife can best plan your care if she knows all the details. And remember, there is very little that can shock a midwife!

And finally, remember that pregnancy is a journey - you will learn more as you go along!

Reassurance for early pregnancy:

Early pregnancy can be a worrying time for many, particularly if you have had a challenging journey to becoming pregnant in the first place.

Know that many symptoms, or even a lack of symptoms, can be normal in the first trimester. You may find you are experiencing nausea and vomiting, tiredness, bloating, breast tenderness, food aversions or none of these symptoms! Every pregnancy is different. It is also normal for symptom levels to fluctuate from day to day. The important thing is to share your concerns so your midwife can provide reassurance.

My advice would be to take it day by day and focus on the smaller steps in front of you. There are also some fantastic resources online ,such as Tommy’s Charity, a website which has an abundance of information to support you during this time.

Key takeaways:

• The booking appointment is an exciting and important step in your maternity journey! It sets out the plan for your pregnancy, although pregnancy is very dynamic and can change.

• It’s an opportunity to learn lots of ways you can stay healthy and support both your health and your baby’s health throughout your pregnancy.

• Taking a high-quality prenatal supplement can be a really great way to support nutritional needs during pregnancy.