Midwife/Antenatal Self Referral

Congratulations on your pregnancy. You don’t need to see the GP when you get pregnant, although we are always happy to see you.

Please fill the form to register for your initial Midwife appointment.

Midwife Booking Form

First Name *

Last Name *

Date of Birth *

Phone Number *

Can a message be left?

Email Address *

Address *

NHS Number *

Find your NHS Number

Do you need an interpreter? *

GP Surgery Name

GP Name (If known)

1st day of Last Menstrual Period *

Is this your first pregnancy? *

Do you consent to an Ultrasound scan?

Do you have any significant medical history or issues with a previous pregnancy? (if applicable)

Please tick the box to confirm you are taking antenatal supplements in line with current NHS advice.*

Do you use any prescription medications or take medications over the counter? *

Do you have diabetes? *

Please write what you are taking if this not currently prescribed by your doctor. *

Please Specify *

Do you smoke? *

We recommend you stop smoking, please contact your Midwife or the GP if you would like help with this.

What is your height in metres? *

What is your weight in kilograms? *

What is your Body Mass Index (BMI)?

At which hospital would you like to deliver?

Please add any additional information you think might be relevant

I want a copy of the contents of this form to be emailed to me

I confirm that I am a registered patient at Harbury Surgery*

Fields marked with an asterisk (*) are mandatory

FAQs

When can I book the initial appointment?

The initial appointment is usually carried out at around 8-10 weeks of pregnancy and lasts around an hour. You will also be offered an Ultrasound Scan appointment at around 12-13 weeks of pregnancy.

What necessary supplements should I consider in the meantime?

Folic acid

For women planning a pregnancy and those who are pregnant 400 micrograms (mcg) of folic acid each day is recommended to reduce the risk of having a baby with a neural tube defect.

Vitamin D

Vitamin D is essential for strong bones and teeth. Our bodies naturally make vitamin D when our skin is exposed to summer sunlight. Vitamin D can also be found in some foods and some fortified cereals.

Whilst pregnant your body needs extra vitamin D to be able to provide baby with enough vitamin D for their first few months of life.

It is recommended that all pregnant and breastfeeding women take 10mcg per day of vitamin D.

Please note: Supplements should not replace a varied healthy diet & are available to buy over the counter Further information can be found here.

What are the vaccinations advised during pregnancy?

Vaccinations during pregnancy:

Flu jab

There is evidence to suggest that pregnant women have a higher chance of developing complications if they get flu, particularly in the later stages of pregnancy. The flu vaccine is normally available from September until around January or February each year. It is free for pregnant women.

As a pregnant lady you're eligible for the vaccine, so try to have it as soon as possible in flu season so that you'll be protected by the time the flu viruses are circulating in the winter.

The flu jab will protect both you and your baby.

Whooping cough (Pertussis) vaccine

Getting vaccinated while you’re pregnant is highly effective in protecting your baby from developing whooping cough in the first few weeks of their life.

The immunity you get from the vaccine will pass to your baby through the placenta and provide passive protection for them until they are old enough to be routinely vaccinated against whooping cough at two months old.

The best time to get vaccinated to protect your baby is from 20 weeks, after you've had your scan, up to 32 weeks of pregnancy.

Please book an appointment with the Practice Nurse for your Flu jab and Whooping Cough vaccines.

Who do I contact in case of further queries?

If you have any concerns about your pregnancy, please contact Bluebell Birth Centre at Warwick Hospital on 01926 600040

Useful Links

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