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Throughout your pregnancy you will likely have multiple midwife appointments. Find out when they will be, how to book and what happens during each one.

Your midwife appointments: what to expect and when to go

### Short on time? Then the key things to know are:

- Midwifery appointments are very flexible and tailored to the woman and her pregnancy needs 
- The midwife will review your physical and mental well being at every antenatal appointment
- Information and education will be provided at every appointment relevant to your gestation period
- We recommend women book a 60 minute appointment in the 3rd trimester to discuss birth preferences

&nbsp;

When you first discover that you are pregnant, the best advice is to contact your GP surgery as soon as possible. You may need a GP appointment to register the pregnancy, although more often than not you can now just let the receptionist know that you’re pregnant and they will let you know what the procedure is for your particular practice. 

Most of the time they will pass your information onto the midwife attached to that surgery and the midwife will contact you directly to arrange a booking appointment.

### How many midwife appointments do you have?

Most women will have between 8-10 midwife appointments during their pregnancy, starting from around 8 weeks. It is standard to also have two ultrasound scans: one at around 12 weeks and one around 20 weeks. Remember that due to the Covid-19 pandemic, many appointments may be delayed.

If you have any health conditions or concerns, you may be offered additional appointments at various points during the pregnancy. Some women will also have more appointments towards the end of their pregnancy if they go over full term.

## Your first midwife appointment 

A booking appointment is your first appointment with the midwife where they will discuss all aspects of your health, family history, social history, any previous pregnancies and any health conditions that you may or may not have.

Taking into account the information that you have supplied, it is at this point that the midwife can decide whether you require care solely from the midwifery team or whether you will need additional input from the obstetric team (Doctors specialising in pregnancy).

[![Get pregnancy advice online](https://api.apiblaster.com/v1/space/5Qc6OKkBkFLskCH:PCBgFVoVfWproj3/media/QdpD1HEUrwBp23O/download?s=0007e7c5da6567e793dda781872f66e4)](https://naytal.uk/pregnancy-support)

### When is my first midwife appointment?

This initial booking appointment ideally takes place between 6-10 weeks gestation. Physically there is not much the midwife can do at this appointment as it is too early to listen to the baby’s heartbeat. Instead the midwife will most likely check your blood pressure and maybe ask for a urine sample.

### What happens at my first midwife appointment?

During your booking appointment, the midwife will give you a rough outline to the plan of your care for the rest of your pregnancy and refer you on to any specialists if necessary. The midwife will then discuss all the antenatal screening that you will be offered at your first scan appointment.

Your first booking appointment is not the best time to discuss your birth preferences - these can be discussed later, usually during your third trimester. However, if you are considering having a homebirth you can certainly ask about the practicalities of this.

It is normal practice to have a chat about safety during pregnancy, with regards to what foods are suitable, caffeine intake, alcohol and pregnancy, intercourse during pregnancy and smoking. If you are a smoker you will likely be referred to a smoking cessation programme.

After your initial booking appointment the midwife will advise you as to when and how you should book in for your next appointment and make you aware of what days the midwives are available. If you need to see the obstetricians for whatever reason, all of these appointments should be arranged for you and you will be notified of the time and the date. They are likely to be held at your local hospital, whereas general midwife appointments are usually at your GP surgery or health centre.

During this appointment the midwife should also highlight who you need to contact in case of any emergency or if you have any concerns. Most hospitals have an early pregnancy unit (EPU) where you are seen if you have any problems before 20 weeks gestation. Usually from 20 weeks onwards you should contact the delivery suite with any issues, however this varies from trust to trust and should be clarified by your midwife at this initial booking appointment. 

## Your 12 week midwife appointment 

This is when you have your first ultrasound scan, during this appointment you will also be offered a whole host of screening tests, testing you and the baby for:

- Down’s syndrome, Edwards’ syndrome and Patau’s syndrome
- HIV, Hepatitis, syphilis
- Rubella status
- Blood group and antibody screening
- Some hospitals may also check your weight and height to confirm your BMI

The first ultrasound scan will confirm your dates for the pregnancy and development of the baby.  You will also have your blood pressure checked and a MSU (mid stream urine sample) will be sent off for analysis.

## Your 16 week midwife appointment 

At every single appointment from this time on, you can expect the midwife to check:

- Your blood pressure
- Urine analysis
- Listen to baby’s heartbeat with a doppler

By 16 weeks, your baby will approximately weigh 100grams, their essential functions are now developed and working well, they have eyebrows, eyelashes and may be able to suck their thumb. 

Hopefully by this time your early pregnancy symptoms have passed and you’re feeling more energetic. Your primary caregiver can listen to the baby’s heartbeat with a doppler and you may start to feel flutters of movement. Women usually start to feel the baby move between 16 to 24 weeks. 

Within your 16 week appointment the midwife will go through:

- Your mental and physical wellbeing 
- The findings from 12 week scan and blood test results 
- Discuss fetal movements
- Bonding with baby 
- Go through antenatal classes and help you find the correct class for you
- Discuss your 20 week scan and what to expect 
- Discuss whooping cough and flu vaccine
- Answer any questions or concerns

## Your 20 week ultrasound scan

This is called an anomaly scan. During this appointment the sonographer (person scanning) will look at the baby as a whole, looking at heart, brain and limbs to make sure everything is where it should be and that there are no anomalies.  

At this appointment it is also sometimes possible to identify the baby’s gender. It is, however, not the sole purpose of this scan and it is not always possible to confirm whether it is a boy or a girl. 

## Your 24 week midwife appointment 

By 24 weeks gestation, your baby now weighs approximately 500g and they’re able to open their eyes and hear. Their fingerprints and footprints are now formed and their skin has become thicker and less transparent. 

Within your 24 week appointment the midwife will go through:

- Your mental and physical wellbeing
- The findings from your 20 week scan 
- Discuss fetal movements and developing patterns
- Birth preparation 
- Answer any questions or concerns

## Your 28 week midwife appointment 

By 28 weeks pregnant your baby now weighs approximately 900g and they can hear, smell and taste. Most babies will now have their own pattern of movements and will have sleep/awake periods. 

Baby can now be monitored by a CTG rather than a doppler if the midwives have any concerns ([find out more here](https://www.esht.nhs.uk/wp-content/uploads/2017/06/0085.pdf)). Within their 28 week appointment the midwife will go through:

- Your mental and physical wellbeing
- Pattern of fetal movements 
- Blood tests and [Gestational Diabetes](https://naytal.uk/blog/gestational-diabetes) screening (if necessary)
- Birth preparation
- Answer any questions or concerns

### Abdominal palpation:

From 28 weeks onwards you can also expect the midwife to check your tummy, otherwise known as an abdominal palpation.

This involves 3 important checks:

1. Observation - looking at the shape and form of the uterus
2. Palpation - feeling the position of the baby and measuring the fundal height (distance between the top of the uterus and the tip of the pubic bone)
3. Auscultation - listening to the fetal heartbeat

[![Speak to a midwife online](https://api.apiblaster.com/v1/space/5Qc6OKkBkFLskCH:PCBgFVoVfWproj3/media/2wP7LVrw4KD169F/download?s=8065603a4cc775b2fcb8ce879e8aaeff)](https://naytal.uk/services/midwife)

## Your 34 week midwife appointment 

Since 24 weeks your baby has been gaining 20-30g per day and by 34 weeks, your baby is now approximately 1700g. From now on, your baby will hopefully be moving into a cephalic (head down position) and be preparing to engage in the pelvis.

Birth preparation will be the main focus of your 34 week appointment. Your midwife will provide information on birth place settings, pain relief options, types of birth, 3rd stage of birth Vitamin K and infant feeding.

Within your 34 week appointment the midwife will go through:

- Your mental and physical health 
- Fetal movements 
- Abdominal palpation
- Birth preparation
- Hospital bag and what to pack (see our [hospital bag checklist](https://naytal.uk/blog/hospital-bag-checklist))
- Answer any questions or concerns

## Your 36 week midwife appointment 

By 36 weeks, your baby is now approximately 2,300g - the continued weight gain and developed fat layer under the skin helps baby to maintain their temperature when they’re born. 

Baby is fully developed and classed as full term at 37 weeks. You may experience braxton hicks (practice contractions) to help engage the baby into the pelvis around this gestation. The 36 week midwife appointment is extremely important and may be the last appointment before you go into labour and meet your baby.

Within your 36 week appointment the midwife will go through:

- Your mental and physical health 
- Fetal movements
 - Abdominal palpation
- Birth preparation (discover [how to write your birth plan](https://naytal.uk/blog/what-to-include-birth-plan))
- Ensure you know signs of labour and when to call your midwife
- Help write your birth preferences
- Answer any questions or concerns

## Your 38 week midwife appointment

At 38 weeks your baby is simply putting on weight. They are fully developed and are now putting down fat stores to be able to keep itself warm when exposed to temperatures outside of the womb. 

Labour can occur at any point and is perfectly safe - so braxton hicks may continue. It is very important at this stage of pregnancy to continue to observe your baby’s pattern of movements.

During this appointment the midwife will go through:

- Your mental and physical health 
- Fetal movements
- Abdominal palpation
- Birth preparation
- Ensure you know signs of labour and when to call your midwife

## Your 40 week midwife appointment 

By 40 weeks you’ll have reached your due date. Approximately 4.4% of babies are born on their estimated due date and more than 95% of babies are head down and engaged into the pelvis at this point. They have gained approximately 150-200g per week since 36 weeks pregnant.

Within your 40 week appointment the midwife will go through:

- Your mental and physical health 
- Fetal movements 
- Abdominal palpation
- Birth preparation
- Risks and benefits of membranes sweeps and [inductions of labour](https://naytal.uk/blog/induction-of-labour-guide)
- Answer any questions or concerns

## Your 41 week midwife appointment 

By 41 weeks, pregnancies are classed as postdates. If you reach 41 weeks, you can opt for a postdates induction with your midwife. Most NHS trusts induce women between 41+4 days and 41+6 days. 

At 42 weeks, pregnancies are classed as post mature. There is [research])http://www.nice.org.uk/guidance/cg70_ which shows that the placenta starts to deteriorate after 42 weeks gestation therefore you’ll be advised to induce the labour.

Within your 41 week appointment the midwife will go through:

- Your mental and physical health 
- Fetal movements
- Abdominal palpation
- Risks and benefits of membrane sweeps and inductions of labour
 - Birth preparation
- Birth preferences if requiring an induction of labour. 

After 41 weeks of pregnancy the midwife may offer another appointment for another membrane sweep before reaching 42 weeks. If you get to 42 weeks and there is no sign of labour, you would be advised to induce the labour. If you choose not to induce the labour you will be asked to attend the hospital daily for CTG monitoring to ensure adequate placental perfusion (making sure the placenta is still working effectively).

## Postnatal care - appointments after birth

You will then be visited by your midwives at home once the baby is born. You will always have a home appointment the day after you have left the hospital or the day after you have given birth if you had the baby at home.

Again your postnatal care will be tailored to your specific needs and should be dependent on how well you are feeling and how baby is doing. This schedule of care will vary greatly depending on how soon after you go home after giving birth.

**Want to speak to someone about your pregnancy? [Book an appointment](https://naytal.uk/services/midwife) with one of our midwives, online at a time that suits you, to get specialist advice about any questions or concerns.**

Midwife Appointments: What Happens and When? | Naytal

Split night sleeping often occurs in infants under one and can be a very challenging time for both babies and parents. Here are some tips to help you manage your baby’s sleep.

How to manage your baby’s split night sleeping

### Short on time? Then the key things to know are:

- Split night sleeping is when your baby wakes in the night after a long sleep and stays alert for an extended period
- Babies waking due to split night sleeping tend to be fully alert, rested, and awake for one long stretch multiple nights a week
- Split nights occur because your baby hasn’t yet aligned their internal body clock with when they feel sleep pressure
- In some cases, babies learning new skills or being unwell can also result in middle-of-the-night wakings
- There are plenty of ways to fix split night sleeping such as reducing or lengthening day time naps, shifting bedtime earlier or later and ensuring they’re not overtired
- The right method for you depends on why your baby is waking in the night and how long they tend to nap for
 
Split night sleeping often occurs in infants under one and can be a very challenging time for both babies and parents. But by understanding why and making simple tweaks to their routine, you can regain a healthy sleep schedule.
 
Here we share some tips to help you manage your baby’s sleep.

## What is split night sleeping?

Split night sleeping happens when your baby or toddler sleeps for a stretch of time at night but then wakes up a few hours later. They then can't fall back asleep for an extended period, with some babies happily staying awake for several hours.
 
The main difference between split nights and regular night time wakings is that babies will be awake for a few hours at a time, normally multiple nights a week, often happy and not wanting to settle. Babies may act playful and be fully alert, therefore unable to fall asleep because they are awake and rested.
 
### The two processes that control how we sleep

Before we can learn how to manage your baby’s split night sleeping, first it’s helpful to understand the two separate processes that impact how our sleep is regulated. These are:
 
- The homeostatic sleep process, and 
- The circadian rhythm with its 24-hour sleep-wake cycle.
 
**The homeostatic sleep process**
Adenosine is a natural chemical that helps us get sleepy, known as sleep pressure. Adults and babies produce and get rid of adenosine in different ways, the key difference being that babies’ levels of adenosine increase whilst they are awake. This means they can only stay awake for a certain amount of time before they start to feel tired. This time is what’s commonly known as awake, or wake windows.

If we already have lots of adenosine, our body will slow down or pause making more. This happens whilst we sleep. Babies that are awake for a long time in the night therefore have less adenosine levels.

**The circadian rhythm**
Next up is the circadian rhythm. This is a natural process that is controlled by our internal biological clock and is affected by how much light and dark we are exposed to. We start to develop a circadian rhythm at about eight weeks old however it’s not yet programmed to our 24/7 cycle.
 
At around three months, we start to produce melatonin which helps us to adapt to a day-night pattern of sleeping. Daytime naps will typically get shorter and babies should spend more time asleep at night. Both this circadian rhythm and the homeostatic sleep process will then start to work together in the evening, helping babies to feel sleepy and stay asleep.

However in the case of split nights, these two processes are misaligned, with sleep pressure continuing to build regardless of the circadian rhythm. That is why some babies will wake in the middle of the night and upon waking, be fully awake.

[![Speak to a baby sleep consultant online](https://api.apiblaster.com/v1/space/5Qc6OKkBkFLskCH:PCBgFVoVfWproj3/media/36tfs18GT6UcCr-/download?s=7d10db20e5fb4e62073940ac3309188c)](https://naytal.uk/services/sleep)

## What causes split night sleeping?

### Too much daytime sleep and too early bedtimes

Infants aged 4 to 12 months will on average sleep between a total of 12 - 16 hours within 24 hours, with the majority of sleep taking place in consolidated stretches at night. For newborn babies, this is anywhere between 14 to 17 hours, or even longer.
 
Some babies can easily nap past the 2-hour mark several times a day which will then interfere with night sleep, particularly if naps occur late in the afternoon. That is because your baby may not have built up enough sleep pressure if put down at their usual bedtime. After all, they have not been awake long enough since their last nap.

### Too little daytime sleep and too early bedtimes

Another scenario where split nights can occur is when your baby struggles with their naps and does not sleep enough during the day. As a result, you may put them to bed earlier than their usual bedtime, and if the 'bad naps' consist, you may do so for the coming days with bedtime incrementally shifting forward.
 
Gradually your baby's sleep pressure will decrease (meaning they don’t feel the need to sleep) and will also misalign with their circadian rhythm, resulting in them waking fully in the night.

### Bedtime is too late or they’re overtired

Say your baby has been awake for longer than comfortable and shows clear signs of overtiredness (reaching peak sleep pressure), yet they are still awake. In this case, their brain may trigger a stress response by releasing cortisol and adrenaline. 
 
High levels of these hormones will begin lowering their sleep pressure levels, making it hard for your baby to settle and stay asleep.

### New skills or illness

Sometimes split nights can also occur because your baby is making a leap in their development and is learning new skills. Often babies are even more susceptible to external stimuli and overstimulation during this time, or they are keen to practise their newly acquired skills in their cot.
 
Equally, illness resulting in physical discomfort can play a major part in babies waking in the middle of the night and ultimately disrupting their sleep.

## What can you do to fix split night sleeping?

### Shift bedtime back

The first step is to adjust your baby's bedtime. For example, if your baby is napping later in the day yet is still being put to sleep at their usual bedtime, try moving bedtime back by 15 to 30 minutes. Then wake them 15 to 30 minutes earlier in the morning. This is a temporary adjustment to help realign their sleep pressure and circadian rhythm.

### Cap their naps

Some babies are ‘nap ninjas’; unphased by noise and able to sleep in any situation. However, we don't want them to oversleep. Try to wake them around the 2-hour mark and then keep them awake for their age-appropriate wake window.

### Lengthen short naps

On the other hand, we have ‘cat nappers’, who sleep 30 minutes or less in one nap during the day. Try to lengthen their naps by making adjustments to their sleep environment such as darkening the room, offering sleep props like a comforter, and learning to soothe them towards the end of their sleep cycle.
 
**Want to speak to someone about baby sleep? Book an appointment with one of our [baby sleep consultants](https://naytal.uk/services/sleep) at a time that suits you to get specialist advice with any concerns.**

#### References

Adams, E.L., Savage, J.S., Master, L. and Buxton, O.M. (2020). Time for bed! Earlier sleep onset is associated with longer nighttime sleep duration during infancy. Sleep Medicine. [online] Available at: https://pubmed.ncbi.nlm.nih.gov/32861189/ [Accessed 12 Mar. 2022].

CDC (2017). CDC - How Much Sleep Do I Need? - Sleep and Sleep Disorders. [online] CDC. Available at: https://www.cdc.gov/sleep/about_sleep/how_much_sleep.html [Accessed 12 Mar. 2022].

Fang, Z. and Rao, H. (2017). Imaging homeostatic sleep pressure and circadian rhythm in the human brain. Journal of Thoracic Disease, [online] 9(5), pp.E495–E498. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5465131/ [Accessed 12 Mar. 2022].

Paavonen, E.J., Morales‐Muñoz, I., Pölkki, P., Paunio, T., Porkka‐Heiskanen, T., Kylliäinen, A., Partonen, T. and Saarenpää‐Heikkilä, O. (2022). Development of sleep–wake rhythms during the first year of age. Journal of Sleep Research, [online] 29(3). Available at: https://onlinelibrary.wiley.com/doi/10.1111/jsr.12918.

Sims, R.E., Wu, H.H.T. and Dale, N. (2013). Sleep-Wake Sensitive Mechanisms of Adenosine Release in the Basal Forebrain of Rodents: An In Vitro Study. PLoS ONE, [online] 8(1), p.e53814. Available at: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0053814 [Accessed 12 Mar. 2022].

Yates, J. (2018). PERSPECTIVE: The Long-Term Effects of Light Exposure on Establishment of Newborn Circadian Rhythm. Journal of Clinical Sleep Medicine, [online] 14(10), pp.1829–1830. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6175794/ [Accessed 12 Mar. 2022].

How to Fix Your Baby's Split Night Sleeping

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