The NICE Antenatal Care Guidelines (NG201)

what the NICE guidelines actually say and what that means for you

The NICE Antenatal Care Guidelines (NG201) are the official framework for what your care during pregnancy should look like. They're written for clinicians so most women never read them, and many never know what they're actually entitled to.

This is the version written for you. Full guidelines at http://nice.org.uk/guidance/ng201 .

Your care should start early

Your first midwife appointment is called the booking appointment (see our article on this) should happen by 10 weeks. Self-referral is a valid option in most areas so you don't need to go through your GP first.

At that first appointment, your midwife will take a full history: your health, your mental health, your family history, your home situation, what medications or supplements you're on. Answer honestly. The more they know, the better they can look after you. Everything is confidential.

How many appointments you should have

first pregnancy = 10 routine appointments with a midwife or doctor

subsequent pregnancies = 7 routine appointments with a midwife or doctor

These are the minimums for an uncomplicated pregnancy. If you have medical, emotional, or social needs that require more support, additional appointments should be offered.

What gets checked and when

Booking

Height, weight, BMI. Blood test for full blood count, blood group, rhesus status. Screening offered for HIV, hepatitis B, syphilis, sickle cell and thalassaemia.

11 - 14 wks

Dating scan. If you choose, combined screening for Down's, Edwards' and Patau's syndromes. You can say yes or no. It is your decision. (Do I have to do all the screening tests I’m offered?)

18- 21 wks

Anomaly scan. Checks fetal structure and placental position. Again this is offered, not required. You can decline any scan.

28 wks

Blood test repeated for full blood count and antibodies. Anti-D injection offered if you're rhesus negative.

What happens at every appointment

Every appointment should include a check-in on your general health and wellbeing. NICE is explicit: your midwife should create space to talk about how things are at home, how you're feeling mentally, any worries about the birth. That's not a bonus if there's time. It's required.

Your antenatal records should be updated at every contact and these stay with you as you are entitled to know what is in them. It also means you can handover your notes to anyone who looks after you in the future.

Domestic abuse - it will be asked

NICE guidelines require your midwife to ask about domestic abuse at your booking appointment sensitively, and when you're alone. This isn't optional and it isn't personal. It's asked of every woman. If you need support, your midwife can help direct you to it.

Mental health is part of antenatal care

Your midwife should ask about previous or current mental health conditions at booking such as anxiety, depression, trauma, psychiatric history. This is so your care plan can account for it, not so it can be held against you. If you've struggled before or are struggling now, say so. You're more likely to get the right support if it's on record.

Ethnicity and deprivation - what the data shows

NICE flags this directly and it's worth knowing. According to the MBRRACE-UK mortality reports, the risk of maternal death during pregnancy is significantly higher for Black women (four times higher than white women), women of mixed ethnic background (three times higher), and Asian women (twice as high). Stillbirth rates follow a similar pattern. Women living in the most deprived areas are more than twice as likely to die compared to women in the least deprived.

This isn't raised to alarm you. It's raised because NICE says healthcare professionals must be aware of it and should be offering closer monitoring and additional support to women in these groups. If you feel your concerns aren't being taken seriously, you are entitled to escalate. Ask for a second opinion or for the head of midwifery.

Know your numbers, know your risk, know your rights.

Your rights - what NICE says you're entitled to, the bit most women don't know....

Every test and every screening offered to you should be explained before it happens. You have the right to accept or decline anything.

The 2015 Montgomery ruling, referenced directly in the NICE guidelines, means healthcare professionals are legally required to discuss all reasonable alternatives, not just their preferred option. This applies to birth choices too, not just antenatal tests. You are not a passive recipient of care. You are a participant in it.

Continuity of carer

NICE recommends that you should, wherever possible, see the same midwife or small team throughout your pregnancy. This isn't what usually happens in practice but what is considered golden practice by the guidelines. Ask what your trust’s continuity is like.

Partners

NICE is clear that partners should be welcomed and included at all points. If a partner wants to come, they should be able to.

The full NICE guidelines are dense and written for clinicians. But they exist for you. Read them if you want to - http://nice.org.uk/guidance/ng201  - or come back to this when something doesn't feel right and you want to know what you should expect.

Source

NICE Guideline NG201 — Antenatal Care. Published August 2021, last reviewed December 2024. http://nice.org.uk/guidance/ng201

MBRRACE-UK Maternal and Perinatal Mortality Reports (referenced within NG201)