Pregnancy

• you or your partner (if you have one) live with a condition – for example epilepsy, diabetes, sickle cell disease or HIV
• you or your partner take prescribed or over-the-counter medicine, or any herbal remedies
• you or your partner have a fertility issue, such as endometriosis or low sperm count
• you cannot have sex or find it difficult to have sex – for example, because of a disability
• you've been trying to get pregnant for 1 year or more through having sex
• you need help to stop smoking, drinking alcohol or using illegal drugs

The 20-week scan is done to check if your baby could have a condition that affects their health and development.

Your baby will be checked for signs of 11 different conditions as part of the scan.

Some conditions can be seen more clearly than others, so the scan may not find everything. But screening is the best way to find any conditions, and help you and your doctors make the best decisions for you and your baby.

Your placenta and the blood flow in your uterus will also be checked.

A 20-week scan is always offered when you're pregnant. It's usually done when you're between 18 and 21 weeks pregnant.

Your midwife will tell you how to book the 20-week scan. How you book depends on which area of the country you are in.

You may:

• be given a form to fill in after your first midwife appointment
• need to book the appointment after your 12-week scan
• need to call your local hospital to book the scan
• get a letter in the post with a prebooked appointment
• need to book the appointment using an app

You'll usually have the scan before you're 21 weeks pregnant, but you're able to have it up until you're 23 weeks pregnant in some cases.

You'll also be told if you need to have a full bladder before the scan.

If you've not had a 20-week scan and you're between 18 and 23 weeks pregnant, tell your midwife or GP.

It's your choice if you want to have a 20-week scan or not. The scan is the best way to find out if your baby has one of the 11 conditions, but not everyone wants this information. Talk to your midwife about your options.

If you decide not to have it but change your mind later, speak to your midwife or GP. They can tell you if you're still able to have the scan.

There are things you can do to prepare for your 20-week scan.

• arrive for your appointment early

• wear loose clothing that's easy to move to get to your tummy

• take out a belly piercing, if you have one

• bring your maternity notes with you, if you have paper notes

• make sure you have a full bladder before the scan, if you've been told to

• check with the hospital or clinic before your appointment if you'll need to pay for pictures of your baby

You can bring someone to the scan with you, but most hospitals do not allow children. Check with the clinic or hospital before your appointment.

Your 20-week scan is usually done at a local hospital, clinic or health centre by a trained healthcare professional.

The ultrasound scan usually takes around 30 minutes. There's no known risk to you, or your baby, from the scan.

The scan can sometimes take longer if your baby is moving around a lot or is not in the right position to get clear pictures.

If this happens, you may be asked to go for a walk or eat something before coming back after a short break so all the checks can be done.

If it's still difficult to get clear pictures of your baby, you'll be offered another appointment before you're 23 weeks pregnant.

The scan cannot find all conditions. If you have any symptoms you're worried about or something does not feel right, it's important to tell your midwife.

During the scan

1. The ultrasound scan will take place in a dimly lit room to get clear pictures of your baby.
2. You'll be asked to lie on a couch and to lift or lower your clothing so the healthcare professional can see and touch your tummy.
3. Tissue paper will be tucked into your clothing before a cold gel is put on your tummy.
4. The healthcare professional will move a handheld device called a probe over your tummy so they can see a picture of your baby and check their body. This may be uncomfortable.
5. They may be quiet while they look closely at your baby's bones, heart, brain, spinal cord, face, kidneys and tummy. They'll also check your placenta and the blood flow in your uterus.
6. Sometimes the healthcare professional may ask another member of the team to check the picture of your baby.
7. You may be asked if you'd like to know the sex of your baby.

You'll be told the results of the 20-week scan after the healthcare professional has done all the checks.

Most people will be told their baby does not have any signs of a condition.

But some people may be told their baby has signs of one of the conditions being checked for.

If your baby has signs of a condition

You'll be told if there are signs your baby may have a health condition after the scan.

If the ultrasound scan finds something, you may be offered more scans and tests, such as amniocentesis or chorionic villus sampling.

You'll be referred to a specialist, who will tell you more about the tests to help you decide if you want to have them.

These tests will be able to tell you if your baby definitely has a health condition and what this means for you and your baby.

The 20-week scan checks your baby to see if they could have a condition that affects their health. It also checks your placenta and uterus.

A 20-week scan is always offered when you're pregnant, usually between 18 and 21 weeks.

How you book your 20-week scan depends on where in the country you are. You may get an appointment letter in the post or have to book it yourself.

If you have paper maternity notes, you should bring them to the 20-week scan, and wear loose clothing. You can usually bring someone with you.

The 20-week scan is usually done in hospital. A device called a probe is used to see a picture of your baby inside your tummy and check their body.

You'll be told the results of your 20-week scan once all the checks have been made. Most babies will not have any signs of a condition.

Screening for sickle cell and thalassaemia is done to find out if there's a chance you could pass on either of these conditions to your baby.

Sickle cell disease and thalassaemia are serious conditions that affect how well your blood carries oxygen. They are caused by having 2 copies of an altered gene, with 1 passed on from each parent.

Screening can tell you if you have the condition or are a carrier of the altered gene (also called having the sickle cell trait or thalassaemia trait).

Anyone can be a carrier of sickle cell or thalassaemia, but it's more likely if your ethnic background is from:

• Africa
• the Caribbean
• the Mediterranean
• the Middle East
• south and southeast Asia

Screening is the best way to find out if there's a chance your baby may have any of these conditions, but it's your choice if you want to have the test.

Knowing whether a baby might have these conditions can help you and your doctors make the best decisions for you and your baby.

It's important to tell your midwife or doctor as soon as possible if you or anyone related to your baby has any of the conditions being checked for.

You'll be offered screening for sickle cell and thalassaemia if you're pregnant.

It's recommended that it's done before you're 10 weeks pregnant but can be done at any time.

You'll usually be given information about screening for sickle cell and thalassaemia at your first midwife appointment (booking appointment).

The screening is offered to everyone who's pregnant, but it's your choice if you want to have it.

Your midwife or doctor may book the blood test appointments for you or tell you how to book them yourself. Sometimes you may have the blood test at your booking appointment.

If you decide not to have the screening but change your mind later, speak to your midwife or GP.

Sickle cell disease is 1 of the conditions that can be checked for as part of the newborn blood spot test after your baby is born. This can be done whether or not you've had the screening in pregnancy.

Screening for thalassaemia is a blood test, which is offered to everyone.

Screening for sickle cell is a questionnaire to check how likely it is your baby could get altered sickle cell genes from either parent.

If your questionnaire suggests you have a higher chance of being a carrier or you live in an area where sickle cell is more common, you'll be offered a blood test for sickle cell.

You can also ask to have the sickle cell blood test even if you are not offered it.

During the blood tests, a healthcare professional will take a small amount of blood from your arm. Your blood will be collected in a small tube and sent to a lab for testing.

There are no known risks to you or your baby from having the blood tests.

There are 2 possible results of the screening test for sickle cell or thalassaemia:

• you're not a carrier of sickle cell or thalassaemia – most people will get this result and will not be offered further tests
• you are a carrier of sickle cell or thalassaemia (or have the condition yourself) and will be offered further tests

If the test shows you're not a carrier, you will be told the results at your next antenatal appointment.

If you do not get your results at your next appointment, speak to your midwife or GP.

If your blood test shows you're a carrier of sickle cell or thalassaemia (or have the condition yourself), you'll be contacted as soon as possible and offered an appointment with a healthcare professional to talk about:

• the results and what they might mean for you and your baby
• your choices and what happens next

The baby's father will be offered a blood test to check if they have an altered gene.

If both parents carry an altered gene, or if the baby's father cannot or does not have the blood test, you can choose to have:

• a test that can tell you if your baby has the condition (either amniocentesis or chorionic villus sampling)
• no further tests

Your maternity team will support you with whatever decision you make.

Antenatal Results and Choices (ARC) offers support and information about screening tests and how you might feel if you're told your baby has or might have a condition.

• Helpline: call 020 7713 7486, Monday to Friday, 10am to 5.30pm
• Text: 07908 683004
• Email: info@arc-uk.org

Screening for sickle cell and thalassaemia checks if you carry these conditions. A baby may have one of these conditions if both parents are carriers.

Anyone who is pregnant is offered screening for sickle cell and thalassaemia. It's ideally done before you're 10 weeks pregnant.

Screening for sickle cell and thalassaemia usually involves a questionnaire and a blood test. Your blood is sent to a lab to test for these conditions

Your midwife or doctor may book the appointments for screening for sickle cell and thalassaemia, or tell you how to book them.

Screening for sickle cell and thalassaemia will tell you if you do or do not carry these conditions.

• you are pregnant and you are thinking about chestfeeding
• you want to take testosterone while chestfeeding
• you are planning to bind your chest and feed your baby
• you are worried that your baby is not getting enough milk

Testosterone can decrease your milk supply so you should also seek advice from your midwife or doctor.

Some mood changes are normal in pregnancy, like feeling tired or irritable.

But if you often feel low and hopeless and no longer enjoy the things you used to, talk to a midwife or GP.

Signs and symptoms of antenatal depression include:

• feeling sad, a low mood, or tearful a lot of the time
• feeling irritable, or getting angry easily
• losing interest in other people and the world around you
• not wanting to eat or eating more than usual
• negative thoughts, such as worrying you will not be able to look after your baby
• feeling guilty, hopeless or blaming yourself for your problems
• having problems concentrating or making decisions

If antenatal depression is not treated your symptoms can get worse and may continue after the baby is born (postnatal depression). So it's important to get help if you need it.

Speak to a GP or your midwife as soon as possible if you think you might have antenatal depression.

With appropriate treatment and support, most people are able to manage their symptoms, though it can take time.

Self-help

A GP or midwife may recommend self-help tips that can help improve your mood. These include:

• talking about your feelings to a friend, family member, doctor or midwife
• trying calming breathing exercises if you feel overwhelmed
• increasing physical activity levels during pregnancy if you can, as it can improve your mood and help you sleep
• attending antenatal classes to meet others who are expecting babies around the same time as you
• eating a healthy diet in pregnancy

Psychological therapy

A GP may recommend a self-help course or refer you for NHS talking therapies.

You may have to wait several weeks to get an appointment. NHS talking therapies might be offered ‘face to face’ or online.

A GP should be able to explain more about different ways you can have talking therapy.

Antidepressants

Antidepressant medicines may be recommended for you if you have moderate or severe depression and:

• you do not want to have psychological therapy
• psychological therapy has not worked for you
• you prefer to take medicine

Some people may benefit from having both psychological therapy and taking antidepressants.

Talk to a GP (or doctor in charge of your care) about antidepressants that are safer to take during pregnancy.

The doctor will usually offer the type with the lowest risk for you and your baby.

Your doctor can explain the risks and the benefits, and will help you decide which treatment is best for you and your baby.

Find out more

• Mind: antidepressants during pregnancy
• Bumps (Best use of medicines in pregnancy): information about the use of medicines in pregnancy

Organisations that may have further, useful information or provide help and support if you have depression during pregnancy include:

• PANDAS: pre and postnatal depression advice and support
• National Childbirth Trust (NCT): antenatal or prenatal depression
• Maternal Mental Health Alliance: mental health support for mums and families
• Tommy's: depression in pregnancy

Symptoms of antenatal depression include feeling sad, tearful, irritable or angry. You may also lose interest in others and the world around you.

Treatments for depression in pregnancy include keeping active, eating a healthy diet, psychological therapy and antidepressants.

If you have depression in pregnancy, organisations like Tommy’s and the National Childbirth Trust (NCT) can provide further information and support.