Antenatal checks and tests

You should arrange your first antenatal consultation as soon as possible.

You do not need to see a doctor or midwife to have your pregnancy confirmed. A home test is as reliable as any test that a doctor can offer.

Call your doctor’s surgery or midwife to arrange your first pregnancy consultation as soon as possible. You should be given an appointment within a week. You can decide whether you wish to have your checkups and tests performed by a doctor or midwife. Contact your municipal health service for an overview of midwives in your municipality.

Checkup 1: weeks 6-12

Your first appointment will cover lifestyle, preparing for pregnancy, labour and birth, breastfeeding and life as a parent. The aim of this appointment is to identify your needs and determine what is important to you.

During your first consultation, you will undergo some routine tests and have some samples taken:

• weight, height and body mass index
• blood pressure
• haemoglobin percentage
• urine samples

These checks will be performed during each checkup. You will be given a health card on which all your results will be recorded. You must take this card with you to all your checkups and to the maternity ward.

During your first checkup, you will be referred for an ultrasound examination.

All pregnant women will also be offered tests for hepatitis B, HIV and syphilis. If you are considered to be at risk of hepatitis B infection during your pregnancy (e.g. as a result of taking drugs using a syringe and needles), it is recommended that you have a number of tests (helsedir.no) (in Norwegain). If the result of any test is positive, you will be referred to a specialist for further treatment.

In addition to the routine tests, your doctor or midwife will talk to you about:

• diet, exercise, smoking and alcohol
• Use of medications
• your state of health and any chronic diseases
• previous pregnancies, births and any abortions
• common ailments and changes during pregnancy
• antenatal care and maternity services where you live
• declaration of paternity if you and the father of your child are not married
• mental health
• any violence and abuse

First-time mothers over 25 years of age and women at risk of developing gestational diabetes will be offered an oral glucose tolerance test (OGTT) at week 24.

If you are over 38 years of age or your 38th birthday falls before your due date, you will be entitled to extended prenatal diagnostics. Your midwife or GP will explain this to you and refer you for further assessment if you so wish.

If you have silicone breast implants or have undergone breast reduction, you may also need more support regarding breastfeeding.

Checkup 2: weeks 18

During your second consultation, an ultrasound examination will be performed to determine your due date as accurately as possible. In addition,

• the number of babies will also be determined
• the location of the placenta in the uterus will also be determined
• the diameter of your baby’s stomach and head will be measured
• you can find out the sex of your baby

This examination will normally be carried out at the outpatient clinic where you are due to have your baby. You will therefore be given an appointment by the clinic.

It is important to be aware that the examination may reveal developmental abnormalities in your baby, although the risk of this is very small. Some abnormalities are tiny and insignificant, while others can be serious. This may present you with some difficult choices.

At the same time, it can be an advantage to be prepared if your baby will need treatment once it has been born. Before you consent to the examination, it can be a good idea to consider whether you wish to be told about any developmental abnormalities in your baby.

Routine ultrasound examination of pregnant women

All pregnant women in Norway are offered an ultrasound examination around week 18 of their pregnancy.

Illustration: Doug Olson / Mostphotos

Checkup 3: week 24

During your third consultation, the growth of your baby and womb (uterus) will be assessed. This examination will be performed during each consultation from week 24 onwards.

Your baby’s heartbeat will also be monitored, and a note will be added to your health card if you are able to detect signs of life. You will also be told what to look out for and what you should do if your baby is not as active as it should be.

• Get help to monitor your baby’s movements at kjennliv.no(in Norwegain)

If you have a Rhesus negative blood type, you will be offered a blood test to determine your baby’s Rhesus type. This is done to prevent your baby from developing complications at a later stage.

If a test shows that the baby of an RhD negative mother is RhD positive, the mother will be offered preventive treatment both during her pregnancy and after the birth. Treatment is administered via a syringe containing specific immunoglobulin against RhD, and is normally given at the hospital at which you are due to give birth.

Written consent

You must give your written consent before being tested for RhD-typing of your baby because the new method that is used is considered to constitute prenatal diagnostics under the provisions of the Biotechnology Act (Section 4-3)(in Norwegian).

‘Prenatal diagnostics’ means the examination of foetal cells, a foetus or a pregnant woman with the aim of obtaining information about the genetic characteristics of the foetus or detecting or excluding diseases or developmental abnormalities in the foetus.

Checkups 4 and 5: weeks 28 and 32

During your fourth consultation, your haemoglobin percentage will be determined again.

During this consultation, you will also be given the chance to arrange a discussion to help you prepare for the birth. You will also be told who to contact in order to sign up for an antenatal course.

You will also be given the opportunity to discuss breastfeeding with a midwife or doctor.

Checkup 6: week 36

Your sixth consultation will be very similar to your previous two consultations, except that the orientation of the baby in your womb will also be checked. If there is any suspicion that the baby may be in the breech position, you will be referred for an ultrasound examination. This will determine whether any further follow-up is necessary.

Time should also be set aside to talk about:

• birth
• maternity leave
• the first few days and weeks after the birth
• home visits by a midwife and public health nurse
• follow-up of your baby by the health clinic
• possibility of contraception after childbirth

Checkups 7, 8 and 9: weeks 38, 40 and 41

The final consultations are very similar to the previous ones. Your blood pressure will be checked, your weight recorded, a urine sample will be taken and the heartbeat of your baby will be monitored.

The orientation of the baby in your womb will also be checked.

This is a good opportunity to bring up any issues you would like to discuss or find out more about. The aim is to ensure that you and your partner feel as safe and secure as possible during this phase.

Overdue checkup

If you have not had your baby by week 41, you will be referred for an overdue checkup at the maternity ward. Responsibility for further follow-up - possible induction of labour - will be transferred to the hospital.

Childbirth

Childbirth typically starts with contractions and consists of three stages of labour: the dilation stage, expulsion stage and placental stage. The time it takes to give birth varies from woman to woman.

Illustration: Doug Olson / Mostphotos

Når fostervatnet går

Mistenker du at fostervatnet har begynt å lekke, skal du alltid ta kontakt med fødeavdelinga eller jordmor/lege.

Illustration: iStockphoto

Newborn screening in Norway

Newborns are offered screening for 25 rare, congenital disorders for which early treatment is vital.

Other samples and tests as necessary

Rubella

If you have not previously had two doses of the rubella vaccine or have previously been shown to have antibodies, you will be offered a blood test to determine whether you are still protected.

If you do not have antibodies in their blood, you will be vaccinated after you have had your baby. The vaccine can be given at a health centre or by a GP.

Hepatitis C

It is recommended that you undergo an examination for hepatitis C if it is possible you have been exposed to infection.

Toxoplasmosis

Pregnant women can test themselves to see whether they have antibodies in their blood. This is recommended if you have a cat or if you visited the Mediterranean region immediately before or during your pregnancy.

Chlamydia

Chlamydia is a sexually transmitted infection in the genital organs, which can occur in the urethra, uterus and fallopian tubes. Chlamydia does not always give rise to symptoms and you should therefore be tested if you are under the age of 25 and/or have had multiple sexual partners.

Herpes

If you experience a herpes outbreak around your genitals for the first time during your pregnancy, you should discuss the matter with your GP or midwife. You will be referred to an obstetrician for further follow-up.