midwife booking visit

Your first midwife appointment

As soon as you find out you are pregnant, contact a GP or midwife and they will help you book your first appointment.

Your first midwife appointment (also called the booking appointment) should happen before you're 10 weeks pregnant. This is because you'll be offered some tests that should be done before 10 weeks.

If you're more than 10 weeks pregnant and have not seen a GP or midwife, contact a GP or midwife as soon as possible.

You'll still have your first midwife appointment and start your NHS pregnancy journey.

Where the first appointment happens

Your first appointment may take place in:

• a GP surgery
• a Children's Centre

Where the appointment happens depends on the pregnancy services in your area.

How long the appointment lasts

The appointment usually takes around an hour.

What your midwife may ask

Your midwife will ask some questions to help find out what care you need.

They may ask about:

• where you live and who you live with
• the baby's father
• any other pregnancies or children
• smoking, alcohol and drug use
• your physical and mental health, and any issues or treatment you've had
• any health issues in your family
• domestic abuse
• female genital mutilation (FGM)
• your job, if you have one
• whether you have people around to help and support you, for example a partner or family members

The first appointment is a chance to tell your midwife if you need help or are worried about anything that might affect your pregnancy. This could include domestic abuse or violence, sexual abuse, or female genital mutilation (FGM) .

FGM can cause problems during labour and birth. It's important you tell your midwife or doctor if this has happened to you.

Tests at your first appointment

Your midwife will ask if they can:

• measure your height and weight, and work out your body mass index (BMI)
• measure your blood pressure and test your urine for signs of pre-eclampsia
• take blood tests to check your general health and blood group, and to see if you have HIV, syphilis or hepatitis B

They'll also offer you a blood test for sickle cell and thalassaemia (blood disorders that can be passed on to the baby) if they think there's a high chance you might have them. They'll work out your chance by asking some questions.

Things your midwife may discuss with you

Your midwife may give you information about:

• how the baby develops during pregnancy
• a healthy pregnancy diet and foods to avoid in pregnancy
• pregnancy exercise and pelvic floor exercises
• your NHS pregnancy (antenatal) care
• breastfeeding
• antenatal classes
• benefits you can get when you're pregnant, such as free prescriptions and free dental care
• your options for where to have your baby
• the tests and scans you'll be offered in pregnancy

Ask questions if you want to know more or do not understand something.

Your maternity notes

At the end of the first appointment, your midwife will give you your maternity notes. The notes may be digital in an app or website or written down in a book or folder.

These notes are a record of your health, appointments and test results in pregnancy. They also have useful phone numbers, for example your maternity unit or midwife team.

You should have these notes with you all the time until you have your baby. This is so healthcare staff can read about your pregnancy health if you need urgent medical care.

Page last reviewed: 22 September 2022 Next review due: 22 September 2025

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The lowdown on your midwife booking appointment

You’re pregnant! So what happens next? Here’s what you need to know

You’ve done the pregnancy test , seen that blue line, you’re pregnant! But what happens next. When do you see a midwife? Get maternity notes? What exactly am I booking in for? We give you the rundown.

What is a booking appointment?

Your booking appointment should be by 10 weeks of your pregnancy is the first appointment you will have with your midwife, and essentially you’re booking in to receive midwifery care from your local NHS trust. You will be given your maternity notes at this stage either as handheld notes or as an electronic patient record (depending on the NHS trust area you're in). The appointment allows your midwife to calculate your due date gather all your medical history, get the personal information on you they need to understand your preferences and health needs. You will also be given lots of advice to support you in having a healthy pregnancy.

It is also your opportunity to ask the questions you may have at this early stage and discuss any worries you may have. Do ask your midwife for your Bounty Pregnancy Information Folder at this appointment.

When will I have a booking appointment?

As soon as you know you are pregnant, please get in touch with your local maternity unit to book your first appointment. This is called your ‘booking appointment’, and you will meet a midwife for the first time.

Ideally you should be seen by a midwife by the time you are 10 weeks pregnant, or as early into your pregnancy as possible.

You can make your first appointment quickly and easily by self-referring directly to your local maternity unit or visiting your GP.

In some units the booking appointment takes place at the hospital rather than in the community and if you have a medical condition that may affect your pregnancy such as diabetes, you may also be given an early appointment with a consultant at the hospital.

You might also like to read:

• Healthy pregnancy diet
• Easy pregnancy exercises
• Your 12-week scan

What will I be asked during my booking appointment?

You will be asked the date of your last period to help your midwife work out your estimated due date.

Your midwife will also want to know about previous pregnancies, and will also want to know if you’ve ever suffered a miscarriage. 

You will also be asked about your family medical history including any genetic conditions. It may seem like a lot of questions and some of them may not seem relevant, but they make sure that those that care for you know about any risks you or your baby may have. 

Your midwife will also ask how you’re feeling about your pregnancy. They aren’t being nosey, it’s standard and it’s best to let your midwife know if you’re feeling anxious or depressed because they’re there to help.

What else will happen at the booking appointment?

These days it’s highly unlikely that you’ll have an internal examination at your booking in appointment. This is only likely to happen when you’re in labour to see how far along you are.

But having blood tests in pregnancy is something to get used to pretty quick and your midwife will take a sample at this stage. The initial blood samples are to determine if you are suffering with anaemia , to determine your blood group and rhesus status and screen you for other conditions that might affect your baby.

You will also be asked for a urine sample to test for a variety of things including pre-eclampsia , gestational diabetes or urinary tract infection (UTI) . 

Your midwife will also check your blood pressure and the results will be added to your maternity notes. High blood pressure is regarded as 140/90 or above.

Your midwife will check your weight and height to calculate your body mass index BMI. If you’re not overweight or underweight this is usually the only time you’ll be weighed. 

If you don’t get given one, make sure you ask for form FW8 (known as a ‘maternity exemption certificate). You need to get this signed by your midwife or doctor to get free dental care and prescriptions during your pregnancy (and up to 1 year afterwards).

When will my next appointment be?

Your next appointment will be determined on whether it is your first pregnancy or not. For first pregnancies you are seen by your midwife at: 16 weeks pregnant, 25 weeks and then every three weeks until you reach 34 weeks pregnant . At that stage you will have a midwife appointment every other week after 34 weeks and you will be seen at 40 weeks and, and again at 41 weeks if baby is overdue and hasn’t arrived. 

If you have a child already, your appointments will be at:  16 weeks, 28 weeks , 34 weeks and then every two weeks until your baby is born.

What if I have concerns between appointments?

If you have any concerns about your pregnancy, you should contact your midwife immediately. Your midwife will give you a 24-hour number to call for such an event.

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Ready Steady Baby

Your booking appointment (booking visit).

Your first main appointment is your booking appointment (booking visit) with your midwife. It normally takes place between 8 and 12 weeks of pregnancy.

Pregnant? Get the best start by seeing your midwife

If you’ve just found out that you’re pregnant, get the best start for you and your baby by making an appointment with a midwife.

Midwife appointments

Make an appointment with your midwife as soon as you know you’re pregnant.

Finding a midwife to help you through your pregnancy’s easy. In most Health Board areas you can make your first midwife appointment by asking your GP receptionist. In some areas you can call the midwifery service direct.

Tests you’ll be offered

At your booking appointment, you’ll:

• have your weight and height measured
• have your blood pressure measured – this will be done again at every midwife appointment to check for pregnancy-induced hypertension or   pre-eclampsia
• be asked to give a urine sample

You’ll probably have   your first scan   arranged too.

What you’ll be asked

Your midwife will ask you about:

• you and your family’s health
• your relationship with your baby’s father or your partner to see whether you or they may need support
• your mental health and how you’re feeling – including if you’ve had mental health difficulties before or if you’re being treated for any now
• whether you drink alcohol and if so how much – if you’ve been drinking during pregnancy speak honestly to your midwife or GP

Your midwife will tell you about screening tests and vaccines available during pregnancy, and will support you to make choices.

Your midwife will also ask about your income and if you would like support to access maternity benefits or welfare advice services.

Give as much information as you can, as it means you’ll get the care that’s best for you and your baby.

Female genital mutilation

During your booking appointment you’ll be asked a question about female genital mutilation (FGM).

It’s important to know if this practice has happened to you. This enables health professionals to plan and provide your care.

FGM Aware   has more information about how FGM is being tackled in Scotland.

What you’ll be told

Your midwife will tell you about:

• the antenatal care in your area
• local services to help you stop smoking, cut down or stop drinking or support you around drug taking – they can also arrange these if needed

They’ll also talk to you about your choices for   where to give birth

What you’ll be given

Your midwife will give you information about:

• the   social care benefits   you can get while you’re pregnant and after your baby’s born
• immunisations recommended in pregnancy
• screening tests in pregnancy   and be offered blood tests if you would like them

Emotional support

Your midwife will ask you questions about your own experiences of growing up. Being pregnant may remind you of difficult emotions from your past. For example, if you ever experienced:

• violence at home
• abuse of any kind
• feeling unsafe or neglected

Be as honest as you can. Understanding your experiences will help your midwife to:

• look after your emotional and physical health
• make sure you and your baby have the best possible care

Can I bring someone with me?

It’s fine for your partner or a friend to come with you. Remember you’re likely to be talking about some confidential and private things.

It’s up to you whether you’d feel more comfortable discussing these things in confidence with just your midwife, or if you’d prefer to have someone else that you trust there as well.

If you need an interpreter, make sure you or your partner tell your midwife before the appointment.

Further information, other languages and alternative formats

Translations and alternative formats of this information are available from   Public Health Scotland .

If you need a different language or format, please contact [email protected].

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Last updated: 16 January 2024

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Prenatal care: 1st trimester visits

Pregnancy and prenatal care go hand in hand. During the first trimester, prenatal care includes blood tests, a physical exam, conversations about lifestyle and more.

Prenatal care is an important part of a healthy pregnancy. Whether you choose a family physician, obstetrician, midwife or group prenatal care, here's what to expect during the first few prenatal appointments.

The 1st visit

When you find out you're pregnant, make your first prenatal appointment. Set aside time for the first visit to go over your medical history and talk about any risk factors for pregnancy problems that you may have.

Medical history

Your health care provider might ask about:

• Your menstrual cycle, gynecological history and any past pregnancies
• Your personal and family medical history
• Exposure to anything that could be toxic
• Medications you take, including prescription and over-the-counter medications, vitamins or supplements
• Your lifestyle, including your use of tobacco, alcohol, caffeine and recreational drugs
• Travel to areas where malaria, tuberculosis, Zika virus, mpox — also called monkeypox — or other infectious diseases are common

Share information about sensitive issues, such as domestic abuse or past drug use, too. This will help your health care provider take the best care of you — and your baby.

Your due date is not a prediction of when you will have your baby. It's simply the date that you will be 40 weeks pregnant. Few people give birth on their due dates. Still, establishing your due date — or estimated date of delivery — is important. It allows your health care provider to monitor your baby's growth and the progress of your pregnancy. Your due date also helps with scheduling tests and procedures, so they are done at the right time.

To estimate your due date, your health care provider will use the date your last period started, add seven days and count back three months. The due date will be about 40 weeks from the first day of your last period. Your health care provider can use a fetal ultrasound to help confirm the date. Typically, if the due date calculated with your last period and the due date calculated with an early ultrasound differ by more than seven days, the ultrasound is used to set the due date.

Physical exam

To find out how much weight you need to gain for a healthy pregnancy, your health care provider will measure your weight and height and calculate your body mass index.

Your health care provider might do a physical exam, including a breast exam and a pelvic exam. You might need a Pap test, depending on how long it's been since your last Pap test. Depending on your situation, you may need exams of your heart, lungs and thyroid.

At your first prenatal visit, blood tests might be done to:

• Check your blood type. This includes your Rh status. Rh factor is an inherited trait that refers to a protein found on the surface of red blood cells. Your pregnancy might need special care if you're Rh negative and your baby's father is Rh positive.
• Measure your hemoglobin. Hemoglobin is an iron-rich protein found in red blood cells that allows the cells to carry oxygen from your lungs to other parts of your body. Hemoglobin also carries carbon dioxide from other parts of your body to your lungs so that it can be exhaled. Low hemoglobin or a low level of red blood cells is a sign of anemia. Anemia can make you feel very tired, and it may affect your pregnancy.
• Check immunity to certain infections. This typically includes rubella and chickenpox (varicella) — unless proof of vaccination or natural immunity is documented in your medical history.
• Detect exposure to other infections. Your health care provider will suggest blood tests to detect infections such as hepatitis B, syphilis, gonorrhea, chlamydia and HIV , the virus that causes AIDS . A urine sample might also be tested for signs of a bladder or urinary tract infection.

Tests for fetal concerns

Prenatal tests can provide valuable information about your baby's health. Your health care provider will typically offer a variety of prenatal genetic screening tests. They may include ultrasound or blood tests to check for certain fetal genetic problems, such as Down syndrome.

Lifestyle issues

Your health care provider might discuss the importance of nutrition and prenatal vitamins. Ask about exercise, sex, dental care, vaccinations and travel during pregnancy, as well as other lifestyle issues. You might also talk about your work environment and the use of medications during pregnancy. If you smoke, ask your health care provider for suggestions to help you quit.

Discomforts of pregnancy

You might notice changes in your body early in your pregnancy. Your breasts might be tender and swollen. Nausea with or without vomiting (morning sickness) is also common. Talk to your health care provider if your morning sickness is severe.

Other 1st trimester visits

Your next prenatal visits — often scheduled about every four weeks during the first trimester — might be shorter than the first. Near the end of the first trimester — by about 12 to 14 weeks of pregnancy — you might be able to hear your baby's heartbeat with a small device, called a Doppler, that bounces sound waves off your baby's heart. Your health care provider may offer a first trimester ultrasound, too.

Your prenatal appointments are an ideal time to discuss questions you have. During your first visit, find out how to reach your health care team between appointments in case concerns come up. Knowing help is available can offer peace of mind.

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• Lockwood CJ, et al. Prenatal care: Initial assessment. https://www.uptodate.com/contents/search. Accessed July 9, 2018.
• Prenatal care and tests. Office on Women's Health. https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/prenatal-care-and-tests. Accessed July 9, 2018.
• Cunningham FG, et al., eds. Prenatal care. In: Williams Obstetrics. 25th ed. New York, N.Y.: McGraw-Hill Education; 2018. https://www.accessmedicine.mhmedical.com. Accessed July 9, 2018.
• Lockwood CJ, et al. Prenatal care: Second and third trimesters. https://www.uptodate.com/contents/search. Accessed July 9, 2018.
• WHO recommendations on antenatal care for a positive pregnancy experience. World Health Organization. http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/anc-positive-pregnancy-experience/en/. Accessed July 9, 2018.
• Bastian LA, et al. Clinical manifestations and early diagnosis of pregnancy. https://www.uptodate.com/contents/search. Accessed July 9, 2018.

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What to expect at your first prenatal appointment

Your kickoff prenatal visit sets the stage for the rest of your pregnancy. Here's what to expect at this information-packed first appointment and how you can prepare.

When to schedule your first prenatal visit

When will your first appointment be, what happens at the first prenatal visit, how to prepare for your first prenatal appointment, what questions to ask at the first prenatal visit.

As soon as you get a positive result on a home pregnancy test , book an appointment with an obstetrician, family physician, or midwife . Depending on the practice, it's normal for another provider in the office, like a nurse practitioner or physician assistant, to handle your first visit.

If you haven't yet chosen a healthcare provider for your pregnancy, that's okay. It's still important to see someone now to start your prenatal care. You can always switch to another provider later. 

Many healthcare providers will schedule your first visit for when you're about 8 weeks pregnant . Some will see you sooner, particularly if you have an existing health condition, had problems with a pregnancy in the past, or are having new or severe symptoms such as vaginal bleeding or abdominal pain .

If you're taking any medications or think you may have been exposed to a hazardous substance, let your provider know as soon as possible.

The first visit will probably be the longest of your prenatal appointments (unless you have complications with your pregnancy along the way). At this and all future visits, don't be afraid to raise any questions or concerns you've been wondering about – it helps to keep a running list between appointments.

Here's what your provider will likely do during your first prenatal visit.

Take your health history. Your provider will ask questions about your gynecological health, personal medical history, and lifestyle habits. Topics commonly covered include:

• Whether your menstrual cycles are regular and how long they tend to last
• The first day of your last period (to determine your due date )
• Symptoms or problems you've noticed since your last period, whether they're related to pregnancy or not
• Current or past gynecological conditions, including sexually transmitted infections
• Details about previous pregnancies
• Current or past diseases and conditions
• Past surgeries or hospitalizations
• Mental health difficulties and diagnoses
• Whether you are being or have been abused , or have another situation that could affect your safety or emotional well-being
• Smoking, drinking, and drug use
• Medications, supplements, vitamins, and herbal drugs you take
• Drug allergies

Your healthcare provider will also ask about your family medical history. Many genetic issues and birth defects are at least partly hereditary, so learning about your family history helps your medical team keep an eye out for potential issues. Let your provider know whether a relative in your or your partner's family has a chromosomal or genetic disorder, had developmental delays, or was born with a structural birth defect.

It's also important to mention any potential exposure to toxins, especially if you live or work near toxic materials.

Check you out and run some tests. You can expect a number of standard exams and tests at your first prenatal visit. Some healthcare providers will do an ultrasound , but if you don't have any medical problems or concerns, it may not be part of the routine. Here's what's typical:

• A thorough physical exam
• A pelvic exam, including a Pap smear (unless you've had one recently) to check for infections such as chlamydia and gonorrhea or abnormal cells that could indicate cervical cancer
• A urine sample to test for urinary tract infections and other conditions

Your provider will also order blood tests to:

• Identify your blood type and Rh status
• Look for anemia
• Check for HIV, syphilis, hepatitis B and, in certain cases, hepatitis C
• Determine immunity to rubella (German measles) and chickenpox

Discuss any high-risk pregnancy concerns. Many people are considered to have high-risk pregnancies , meaning there's a higher-than-average chance of health issues during pregnancy, labor, and birth. High-risk groups include those who:

• Become pregnant for the first time at age 35 or older
• Become pregnant for the first time before age 18
• Have certain medical issues that develop during pregnancy, such as preeclampsia and gestational diabetes
• Have certain preexisting health problems, such as high blood pressure , thyroid disease , or type 1 or type 2 diabetes

High-risk pregnancies need extra care. While many potential complications are treatable or temporary, some can be dangerous to both you and your baby. Your provider will talk through the risks at your first visit and throughout your pregnancy – and don't be afraid to ask questions at any point.

Explain your options for prenatal genetic testing. Your provider will offer you various prenatal screenings that can give you information about your baby's risk for birth defects and chromosomal conditions. These tests include:

• Noninvasive prenatal testing (NIPT) , also called cell-free fetal DNA testing. Performed at 9 weeks or later, it's used to examine the little bits of your baby's DNA present in your blood.
• A first trimester screen, also called a first-trimester combined test. Typically done between weeks 11 and 13, it consists of a blood test and a type of ultrasound called a nuchal translucency .
• A carrier screening if you haven't had one already. It's a simple blood or saliva test done to see whether your baby is at risk for any of 100 genetic disorders such as cystic fibrosis, sickle cell disease, thalassemia, and Tay-Sachs disease.

Finally, if you're high-risk, there are invasive genetic diagnostic tests that can tell you for sure whether your baby has Down syndrome or certain other conditions. These tests include chorionic villus sampling (CVS) , generally performed at 10 to 13 weeks, and amniocentesis , usually done at 16 to 20 weeks.

CVS and amniocentesis are invasive and may carry a small risk of miscarriage , so women who choose to have these procedures are usually those with a higher risk for genetic and chromosomal problems. Some moms-to-be choose to wait for the results of screening tests before deciding whether to have one of these diagnostic tests.

For more information, your provider can refer you to a genetic counselor .

Give you advice and let you know what's ahead. Your healthcare provider will give you information about eating well , foods to avoid , healthy weight gain , and prenatal vitamins . They'll also give you a heads-up about the common discomforts of early pregnancy and let you know which pregnancy symptoms require immediate attention .

Your emotional health is very important. Your provider may screen you for signs of depression during pregnancy . But don't wait to be asked. If you're feeling depressed or anxious, let your provider know so they can refer you to someone who can help.

The dangers of smoking , drinking alcohol, using drugs, and taking certain medications will be a topic of discussion, as well. If you need help quitting smoking or any other substance, your provider can recommend a program or counselor.

Other topics include the do's and don'ts of exercise , travel , and sex during pregnancy ; environmental and occupational hazards that can affect your baby; and how to avoid certain infections, such as toxoplasmosis . Your provider will also discuss recommended vaccinations , like the flu shot and the COVID-19 vaccine .

To help your visit go as smoothly as possible, try taking the following steps.

Review your medical history. Brush up on your health status so you can better answer questions. This includes information about your:

• Overall physical and mental health
• Current and past diseases, conditions and other health issues
• Current medications, including prescriptions, supplements, vitamins and herbal supplements and teas
• Fertility and pregnancy history
• Family medical history
• Partner's medical history

If possible, bring documentation along, such as immunization records or a list of your medications. You may even want to bring a baggie containing the medications themselves.

Take your partner, a family member, or friend. Another person can write down notes, ask questions, and provide emotional support during this information-dense first visit.

Get there on time or a little early. This can be helpful for filling out forms and reviewing your insurance. Make sure to bring your insurance information and cash or a credit card for any necessary co-pays.

Just as your provider will ask you questions at your first prenatal visit, it's a good idea to come prepared with a list of questions for your provider. Ask anything – and don't be shy. Again, try to keep a running list in the weeks before the appointment, so nothing important slips your mind.

Here are some questions to consider if your provider doesn't bring up the topic first.

• How much weight gain is healthy for me? The first prenatal visit is a great opportunity to learn about how your body will change. It's also a good time to ask about nutrition, including which foods to prioritize in your diet.
• What are the foods I should avoid ? Raw fish and unpasteurized cheeses are long-established no-no's for pregnant people, but ask your provider for a full list of what to skip, since the accepted wisdom has changed over the years. Ask about caffeine and alcohol, too. Coffee is typically alright in limited doses, but no amount of alcohol is considered safe when you're having a baby.
• Are prenatal supplements a good choice? Your provider will likely recommend a prenatal vitamin containing folic acid and iron, both of which are needed more during pregnancy.
• Can I exercise? What about sex? With some exceptions, both are usually okay when you're pregnant. They're important to discuss, however, since certain conditions may complicate matters.
• Is it safe to keep working? If you have a physically or emotionally demanding job , you may want to ask how you can ease the effects on your body and mind.
• Is travel okay? While planes, trains, and automobiles are typically safe well into pregnancy, people with particular complications may need to limit or avoid traveling.
• Which medications are safe to take? Ask about your current prescriptions, herbal products, teas, supplements, and any over-the-counter drugs you may use, such as pain relievers and cold medicines. Non-steroidal inflammatory drugs (NSAIDs) like ibuprofen and naproxen are not recommended, for example.
• What are common symptoms of pregnancy? Your provider can tell you what to expect and how to cope. Remember to ask what symptoms are uncommon, too, and what red flags to watch for.
• What should I do in an emergency? Find out who to contact and where to go if you begin to experience new, unusual, severe, or long-lasting symptoms.
• Who will treat me over the course of my pregnancy? If your provider is part of a group practice, you may see other members of the group during appointments. They may even deliver your baby.
• Do you recommend taking prenatal classes? Whether they're in a hospital, at a university, online, or somewhere else, prenatal classes can be invaluable learning experiences for parents-to-be. On top of the usual childbirth classes you hear about, you can also find courses in everything from stress management to good nutrition and even breastfeeding.

Last but not least, ask about your next visit and schedule the appointment before leaving the office. Until your 28th week of pregnancy, you'll likely see someone every four weeks or so.

You may also want to ask whether future visits will be in-person or virtual. Certain practices offer virtual visits for low-risk patients, those whose providers aren't close by, or even higher-risk patients that need to be evaluated more often.

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Prenatal visits: What to expect and how to prepare

What happens at second trimester prenatal appointments

NIPT (Noninvasive prenatal testing)

Chorionic villus sampling (CVS)

BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies .

March of Dimes. 2017. Prenatal Care Checkups.  https://www.marchofdimes.org/pregnancy/prenatal-care-checkups.aspx Opens a new window  [Accessed March 2024]

MedlinePlus. 2022. Prenatal care in your first trimester.  https://medlineplus.gov/ency/patientinstructions/000544.htm Opens a new window  [Accessed March 2024]

Mayo Clinic. 2022. Prenatal care: 1 st  trimester visits.  https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/prenatal-care/art-20044882 Opens a new window  [Accessed March 2024]

American Pregnancy Association. (2021). Your First Prenatal Visit.  https://americanpregnancy.org/healthy-pregnancy/planning/first-prenatal-visit/ Opens a new window  [Accessed March 2024]

Kids Health. 2022. Prenatal Visits: First Trimester.  https://kidshealth.org/en/parents/tests-first-trimester.html Opens a new window  [Accessed March 2024]

Mount Sinai. 2021. Prenatal care in your first trimester.  https://www.mountsinai.org/health-library/selfcare-instructions/prenatal-care-in-your-first-trimester Opens a new window  [Accessed January 2024]

Centers for Disease Control and Prevention. 2022. Recommended Clinician Timeline for Screening for Syphilis, HIV, HBV, HCV, Chlamydia, and Gonorrhea.  https://www.cdc.gov/nchhstp/pregnancy/screening/clinician-timeline.html Opens a new window  [Accessed March 2024]

Alabama Perinatal Excellence Collaborative. 2015. APEC Guidelines for Routine Prenatal Care.  http://apecguidelines.org/wp-content/uploads/2016/07/Routine-Prenatal-Care-6-30-2015.pdf Opens a new window  [Accessed March 2024]

Kids Health. 2019. Toxoplasmosis.  https://kidshealth.org/en/parents/toxoplasmosis.html Opens a new window  [Accessed March 2024]

NIH: Eunice Kennedy Shriver National Institute of Child Health and Human Development. 2017. What is a high-risk pregnancy?  https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/high-risk Opens a new window  [Accessed March 2024]

Kids Health. 2022. What's a “High-Risk” Pregnancy?  https://kidshealth.org/en/parents/high-risk.html Opens a new window  [Accessed March 2024]

NIH: Eunice Kennedy Shriver National Institute of Child Health and Human Development. 2018. What are some factors that make a pregnancy high risk?  https://www.nichd.nih.gov/health/topics/high-risk/conditioninfo/factors Opens a new window  [Accessed March 2024]

March of Dimes. 2020. Prenatal Tests.  https://www.marchofdimes.org/pregnancy/prenatal-tests.aspx Opens a new window  [Accessed March 2024]

American College of Obstetricians and Gynecologists. 2022. Carrier Screening.  https://www.acog.org/womens-health/faqs/carrier-screening Opens a new window  [Accessed March 2024]

March of Dimes. 2020. Chorionic Villus Sampling.  https://www.marchofdimes.org/pregnancy/chorionic-villus-sampling.aspx Opens a new window  [Accessed March 2024]

Office on Women's Health. 2021. Prenatal care and tests.  https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/prenatal-care-and-tests Opens a new window  [Accessed March 2024]

MedlinePlus. 2021. What is noninvasive prenatal testing (NIPT) and what disorders can it screen for?  https://medlineplus.gov/genetics/understanding/testing/nipt/ Opens a new window  [Accessed March 2024]

Voyage Healthcare. 2021. Prenatal Care Overview.  https://www.voyagehealthcare.com/how-to-make-the-most-of-your-first-prenatal-visit-guide Opens a new window  [Accessed March 2024]

Gifford Health Care. Undated. Preparing for Your Appointment.  https://giffordhealthcare.org/patients/preparing-for-your-appointment/ Opens a new window  [Accessed March 2024]

Mayo Clinic. 2023. Pregnancy nutrition: Foods to avoid during pregnancy.  https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy-nutrition/art-20043844 Opens a new window  [Accessed March 2024]

American College of Obstetricians and Gynecologists. 2023. Nutrition During Pregnancy.  https://www.acog.org/womens-health/faqs/nutrition-during-pregnancy Opens a new window  [Accessed March 2024]

Mayo Clinic. 2022. Prenatal vitamins: Why they matter, how to choose.  https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/prenatal-vitamins/art-20046945 Opens a new window  [Accessed March 2024]

American College of Obstetricians and Gynecologists. 2022. Exercise During Pregnancy.  https://www.acog.org/womens-health/faqs/exercise-during-pregnancy Opens a new window  [Accessed March 2024]

Mayo Clinic. 2022. Sex during pregnancy: What's OK, what's not.  https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/sex-during-pregnancy/art-20045318 Opens a new window  [Accessed March 2024]

Kids Health. 2022. Sex During Pregnancy.  https://kidshealth.org/en/parents/sex-pregnancy.html Opens a new window  [Accessed March 2024]

American College of Obstetricians and Gynecologists. 2023. Travel During Pregnancy.  https://www.acog.org/womens-health/faqs/travel-during-pregnancy Opens a new window  [Accessed March 2024]

March of Dimes. 2020. Over-the-counter medicine, supplements and herbal products during pregnancy.  https://www.marchofdimes.org/pregnancy/over-the-counter-medicine-supplements-and-herbal-products.aspx Opens a new window  [Accessed March 2024]

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Your First Prenatal Appointment

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• NICE Guidance
• Conditions and diseases
• Fertility, pregnancy and childbirth

Antenatal care

NICE guideline [NG201] Published: 19 August 2021

• Tools and resources
• Information for the public

Recommendations

• Recommendations for research
• Rationale and impact
• Finding more information and committee details
• Update information

1.1 Organisation and delivery of antenatal care

1.2 routine antenatal clinical care, 1.3 information and support for pregnant women and their partners, 1.4 interventions for common problems during pregnancy, terms used in this guideline.

People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care .

Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Supporting women to make decisions about their care is important during pregnancy. Healthcare professionals should ensure that women have the information they need to make decisions and to give consent in line with General Medical Council (GMC) guidance , the Nursing and Midwifery Council (NMC) Code and the 2015 Montgomery ruling .

Please note that the Royal College of Obstetricians and Gynaecologists has produced guidance on COVID-19 and pregnancy for all midwifery and obstetric services.

Starting antenatal care

1.1.1 Ensure that antenatal care can be started in a variety of straightforward ways, depending on women's needs and circumstances, for example, by self-referral, referral by a GP, midwife or another healthcare professional, or through a school nurse, community centre or refugee hostel.

1.1.2 At the point of antenatal care referral:

Provide an easy-to-complete referral form.

Offer early pregnancy health and wellbeing information before the booking appointment. This should include information about modifiable factors that may affect the pregnancy, including stopping smoking, avoiding alcohol, taking supplements, and eating healthily. See also recommendation 1.3.9 and the NICE guidelines on maternal and child nutrition , vitamin D , and smoking: stopping in pregnancy and after childbirth .

Ensure that the materials are available in different languages or formats such as digital, printed, braille or Easy Read.

1.1.3 The referral form for women to start antenatal care should:

enable healthcare professionals to identify women with:

specific health and social care needs

risk factors, including those that can potentially be addressed before the booking appointment, for example, smoking

include contact details about the woman's GP.

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on starting antenatal care .

Full details of the evidence and the committee's discussion are in evidence review F: accessing antenatal care .

Antenatal appointments

1.1.4 Offer a first antenatal (booking) appointment with a midwife to take place by 10+0 weeks of pregnancy.

1.1.5 If women contact or are referred to maternity services later than 9+0 weeks of pregnancy, offer a first antenatal (booking) appointment to take place within 2 weeks if possible.

1.1.6 If a woman books late in pregnancy, ask about the reasons for the late booking because it may reveal social, psychological or medical issues that need to be addressed.

1.1.7 Plan 10 routine antenatal appointments with a midwife or doctor for nulliparous women. (See schedule of appointments .)

1.1.8 Plan 7 routine antenatal appointments with a midwife or doctor for parous women. (See schedule of appointments .)

1.1.9 Also see the NICE guideline on pregnancy and complex social factors for:

women who misuse substances

recent migrants, asylum seekers or refugees, or women who have difficulty reading or speaking English

young women aged under 20

women who experience domestic abuse.

1.1.10 Offer additional or longer antenatal appointments if needed, depending on the woman's medical, social and emotional needs. Also see the NICE guidelines on pregnancy and complex social factors , intrapartum care for women with existing medical conditions or obstetric complications and their babies , hypertension in pregnancy , diabetes in pregnancy and twin and triplet pregnancy .

1.1.11 Ensure that reliable interpreting services are available when needed, including British Sign Language. Interpreters should be independent of the woman rather than using a family member or friend.

1.1.12 Those responsible for planning and delivering antenatal services should aim to provide continuity of carer .

1.1.13 Ensure that there is effective and prompt communication between healthcare professionals who are involved in the woman's care during pregnancy.

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on antenatal appointments .

Full details of the evidence and the committee's discussion are in:

evidence review H: timing of first antenatal appointment

evidence review I: number of antenatal appointments

evidence review J: referral and delivery of antenatal care .

Involving partners

1.1.14 A woman can be supported by a partner during her pregnancy so healthcare professionals should:

involve partners according to the woman's wishes and

inform the woman that she is welcome to bring a partner to antenatal appointments and classes.

1.1.15 Consider arranging the timing of antenatal classes so that the pregnant woman's partner can attend, if the woman wishes.

1.1.16 When planning and delivering antenatal services, ensure that the environment is welcoming for partners as well as pregnant women by, for example:

providing information about how partners can be involved in supporting the woman during and after pregnancy

providing information about pregnancy for partners as well as pregnant women

displaying positive images of partner involvement (for example, on notice boards and in waiting areas)

providing seating in consultation rooms for both the woman and her partner

considering providing opportunities for partners to attend appointments remotely as appropriate.

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on involving partners .

Full details of the evidence and the committee's discussion are in evidence review C: involving partners and evidence review B: approaches to information provision .

Taking and recording the woman's history

1.2.1 At the first antenatal (booking) appointment, ask the woman about:

her medical history, obstetric history and family history (of both biological parents)

previous or current mental health concerns such as depression, anxiety, severe mental illness, psychological trauma or psychiatric treatment, to identify possible mental health problems in line with the section on recognising mental health problems in pregnancy and the postnatal period and referral in the NICE guideline on antenatal and postnatal mental health

current and recent medicines, including over-the-counter medicines, health supplements and herbal remedies

her occupation, discussing any risks and concerns

her family and home situation, available support network and any health or other issues affecting her partner or family members that may be significant for her health and wellbeing

other people who may be involved in the care of the baby

contact details for her partner and her next of kin

factors such as nutrition and diet, physical activity, smoking and tobacco use, alcohol consumption and recreational drug use (see also recommendations 1.3.8 and 1.3.9 ).

1.2.2 Consider reviewing the woman's previous medical records if needed, including records held by other healthcare providers.

1.2.3 Be aware that, according to the 2020 MBRRACE-UK reports on maternal and perinatal mortality , women and babies from some minority ethnic backgrounds and those who live in deprived areas have an increased risk of death and may need closer monitoring and additional support. The reports showed that:

compared with white women (8/100,000), the risk of maternal death during pregnancy and up to 6 weeks after birth is:

4 times higher in black women (34/100,000)

3 times higher in women with mixed ethnic background (25/100,000)

2 times higher in Asian women (15/100,000; does not include Chinese women)

compared with white babies (34/10,000), the stillbirth rate is

more than twice as high in black babies (74/10,000)

around 50% higher in Asian babies (53/10,000)

women living in the most deprived areas (15/100,000) are more than 2.5 times more likely to die compared with women living in the least deprived areas (6/100,000)

the stillbirth rate increases according to the level of deprivation in the area the mother lives in, with almost twice as many stillbirths for women living in the most deprived areas (47/10,000) compared with the least deprived areas (26/10,000).

1.2.4 If the woman or her partner smokes or has stopped smoking within the past 2 weeks, offer a referral to NHS Stop Smoking Services in line with the NICE guideline on smoking: stopping in pregnancy and after childbirth . Also see the NICE guideline on smokeless tobacco: South Asian communities .

1.2.5 Ask the woman about domestic abuse in a kind, sensitive manner at the first antenatal (booking) appointment, or at the earliest opportunity when she is alone. Ensure that there is an opportunity to have a private, one‑to‑one discussion. Also see the NICE guideline on domestic violence and abuse and the section on pregnant women who experience domestic abuse in the NICE guideline on pregnancy and complex social factors .

1.2.6 Assess the woman's risk of and, if appropriate, discuss female genital mutilation (FGM) in a kind, sensitive manner. Take appropriate action in line with UK government guidance on safeguarding women and girls at risk of FGM .

1.2.7 Refer the woman for a clinical assessment by a doctor to detect cardiac conditions if there is a concern based on the pregnant woman's personal or family history. See also the section on heart disease in the NICE guideline on intrapartum care for women with existing medical conditions or obstetric complications and their babies .

1.2.8 Refer the woman to an obstetrician or other relevant doctor if there are any medical concerns or if review of current long-term medicines is needed.

1.2.9 After discussion with and agreement from the woman, contact the woman's GP to share information about the pregnancy and potential concerns or complications during pregnancy.

1.2.10 At every antenatal appointment, carry out a risk assessment as follows:

ask the woman about her general health and wellbeing

ask the woman (and her partner, if present) if there are any concerns they would like to discuss

provide a safe environment and opportunities for the woman to discuss topics such as concerns at home, domestic abuse, concerns about the birth (for example, if she previously had a traumatic birth) or mental health concerns

review and reassess the plan of care for the pregnancy

identify women who need additional care.

1.2.11 At every antenatal contact, update the woman's antenatal records to include details of history, test results, examination findings, medicines and discussions.

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on taking and recording the woman's history .

Full details of the evidence and the committee's discussion are in evidence review G: content of antenatal appointments .

Examinations and investigations

1.2.12 At the first face-to-face antenatal appointment:

offer to measure the woman's height and weight and calculate body mass index

offer a blood test to check full blood count, blood group and rhesus D status.

1.2.13 At the first antenatal (booking) appointment, discuss and share information about, and then offer, the following screening programmes:

NHS infectious diseases in pregnancy screening programme (HIV, syphilis and hepatitis B)

NHS sickle cell and thalassaemia screening programme

NHS fetal anomaly screening programme . Inform the woman that she can accept or decline any part of any of the screening programmes offered.

1.2.14 Offer pregnant women an ultrasound scan to take place between 11+2 weeks and 14+1 weeks to:

determine gestational age

detect multiple pregnancy

and if opted for, screen for Down's syndrome, Edwards' syndrome and Patau's syndrome (see the NHS fetal anomaly screening programme ).

1.2.15 Offer pregnant women an ultrasound scan to take place between 18+0 weeks and 20+6 weeks to:

screen for fetal anomalies (see the NHS fetal anomaly screening programme )

determine placental location.

1.2.16 At the antenatal appointment at 28 weeks, offer:

anti-D prophylaxis to rhesus-negative women in line with NICE's technology appraisal guidance on routine antenatal anti-D prophylaxis for women who are rhesus D negative (see also NICE's diagnostics guidance on high-throughput non-invasive prenatal testing for fetal RHD genotype )

a blood test to check full blood count, blood group and antibodies.

1.2.17 If there are any unexpected results from examinations or investigations, offer referral according to local pathways and ensure appropriate information provision and support.

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on examinations and investigations .

Venous thromboembolism

1.2.18 Assess the woman's risk factors for venous thromboembolism at the first antenatal (booking) appointment, and after any hospital admission or significant health event during pregnancy. Consider using guidance by an appropriate professional body, for example, the Royal College of Obstetricians and Gynaecologists' guideline on reducing the risk of venous thromboembolism during pregnancy .

1.2.19 For pregnant women who are admitted to a hospital or a midwife-led unit, see the section on interventions for pregnant women and women who gave birth or had a miscarriage or termination of pregnancy in the past 6 weeks in the NICE guideline on venous thromboembolism in over 16s .

1.2.20 For women at risk of venous thromboembolism, offer referral to an obstetrician for further management.

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on venous thromboembolism .

Full details of the evidence and the committee's discussion are in evidence review N: risk factors for venous thromboembolism in pregnancy .

Gestational diabetes

1.2.21 At the first antenatal (booking) appointment, assess the woman's risk factors for gestational diabetes in line with the recommendations on gestational diabetes risk assessment in the NICE guideline on diabetes in pregnancy .

1.2.22 If a woman is at risk of gestational diabetes, offer referral for an oral glucose tolerance test to take place between 24+0 weeks and 28+0 weeks in line with the recommendations on gestational diabetes risk assessment and the recommendations on gestational diabetes testing in the NICE guideline on diabetes in pregnancy.

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on gestational diabetes .

Pre-eclampsia and hypertension in pregnancy

1.2.23 At the first antenatal (booking) appointment and again in the second trimester, assess the woman's risk factors for pre-eclampsia, and advise those at risk to take aspirin in line with the section on antiplatelet agents in the NICE guideline on hypertension in pregnancy .

1.2.24 Measure and record the woman's blood pressure at every routine face-to-face antenatal appointment using a device validated for use in pregnancy, and following the recommendations on measuring blood pressure in the NICE guideline on hypertension in adults .

1.2.25 For women under 20+0 weeks with hypertension, follow the recommendations on the management of chronic hypertension in pregnancy in the NICE guideline on hypertension in pregnancy .

1.2.26 Refer women over 20+0 weeks with a first episode of hypertension (blood pressure of 140/90 mmHg or higher) to secondary care to be seen within 24 hours. See the recommendations on diagnosing hypertension in the NICE guideline on hypertension in adults .

1.2.27 Urgently refer women with severe hypertension (blood pressure of 160/110 mmHg or higher) to secondary care to be seen on the same day. The urgency of the referral should be determined by an overall clinical assessment.

1.2.28 Offer a urine dipstick test for proteinuria at every routine face-to-face antenatal appointment.

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on pre-eclampsia and hypertension in pregnancy .

Full details of the evidence and the committee's discussion are in evidence review K: identification of hypertension in pregnancy and evidence review G: content of antenatal appointments .

Monitoring fetal growth and wellbeing

1.2.29 Offer a risk assessment for fetal growth restriction at the first antenatal (booking) appointment, and again in the second trimester. Consider using guidance by an appropriate professional or national body, for example, the Royal College of Obstetricians and Gynaecologists' guideline on the investigation and management of the small-for-gestational-age fetus or the NHS saving babies' lives care bundle version 2 .

1.2.30 Offer symphysis fundal height measurement at each antenatal appointment after 24+0 weeks (but no more frequently than every 2 weeks) for women with a singleton pregnancy unless the woman is having regular growth scans. Plot the measurement onto a growth chart in line with the NHS saving babies' lives care bundle version 2 .

1.2.31 If there are concerns that the symphysis fundal height is large for gestational age, consider an ultrasound scan for fetal growth and wellbeing.

1.2.32 If there are concerns that the symphysis fundal height is small for gestational age, offer an ultrasound scan for fetal growth and wellbeing, the urgency of which may depend on additional clinical findings, for example, reduced fetal movements or raised maternal blood pressure.

1.2.33 Do not routinely offer ultrasound scans after 28 weeks for uncomplicated singleton pregnancies.

1.2.34 Discuss the topic of babies' movements with the woman after 24+0 weeks, and:

ask if she has any concerns about her baby's movements at each antenatal contact after 24+0 weeks

advise her to contact maternity services at any time of day or night if she has any concerns about her baby's movements or she notices reduced fetal movements after 24+0 weeks

assess the woman and baby if there are any concerns about the baby's movements.

1.2.35 Service providers should recognise that the use of structured fetal movement awareness packages , such as the one studied in the AFFIRM trial, has not been shown to reduce stillbirth rates.

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on monitoring fetal growth and wellbeing .

evidence review O: monitoring fetal growth

evidence review P: fetal movement monitoring

evidence review Q: routine third trimester ultrasound for fetal growth .

Breech presentation

1.2.36 Offer abdominal palpation at all appointments after 36+0 weeks to identify possible breech presentation for women with a singleton pregnancy.

1.2.37 If breech presentation is suspected on abdominal palpation, offer an ultrasound scan to determine the presentation.

1.2.38 For women with an uncomplicated singleton pregnancy with breech presentation confirmed after 36+0 weeks:

discuss the different options available and their benefits, risks and implications, including:

external cephalic version (to turn the baby from bottom to head down)

breech vaginal birth

elective caesarean birth

for women who prefer cephalic (head-down) vaginal birth, offer external cephalic version. Also see the recommendations on breech presentation in the NICE guideline on caesarean birth , and the recommendations on breech presenting in labour in the NICE guideline on intrapartum care for women with existing medical conditions or obstetric complications and their babies .

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on breech presentation .

Full details of the evidence and the committee's discussion are in evidence review L: identification of breech presentation and evidence review M: management of breech presentation .

Communication – key principles

1.3.1 When caring for a pregnant woman, listen to her and be responsive to her needs and preferences. Also see the NICE guideline on patient experience in adult NHS services , in particular the sections on communication and information , and the NICE guideline on shared decision making .

1.3.2 Ensure that when offering any assessment, intervention or procedure, the risks, benefits and implications are discussed with the woman and she is aware that she has a right to decline.

1.3.3 Women's decisions should be respected, even when this is contrary to the views of the healthcare professional.

1.3.4 When giving women (and their partners ) information about antenatal care, use clear language, and tailor the timing, content and delivery of information to the needs and preferences of the woman and her stage of pregnancy. Information should support shared decision making between the woman and her healthcare team, and be:

offered on a one-to-one or couple basis

supplemented by group discussions (women only or women and partners)

supplemented by written information in a suitable format, for example, digital, printed, braille or Easy Read

offered throughout the woman's care

individualised and sensitive

supportive and respectful

evidence-based and consistent

translated into other languages if needed. For more guidance on communication, providing information (including different formats and languages), and shared decision making, see the NICE guideline on patient experience in adult NHS services and the NHS Accessible Information Standard .

1.3.5 Explore the knowledge and understanding that the woman (and her partner) has about each topic to individualise the discussion.

1.3.6 Check that the woman (and her partner) understands the information that has been given, and how it relates to them. Provide regular opportunities to ask questions, and set aside enough time to discuss any concerns.

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on communication – key principles .

evidence review B: approaches to information provision

evidence review A: information provision

evidence review J: referral and delivery of antenatal care .

Information about antenatal care

1.3.7 At the first antenatal (booking) appointment, discuss antenatal care with the woman (and her partner) and provide her schedule of antenatal appointments .

1.3.8 At the first antenatal (booking) appointment (and later if appropriate), discuss and give information on:

what antenatal care involves and why it is important

the planned number of antenatal appointments

where antenatal appointments will take place

which healthcare professionals will be involved in antenatal appointments

how to contact the midwifery team for non-urgent advice

how to contact the maternity service about urgent concerns, such as pain and bleeding

screening programmes: what blood tests and ultrasound scans are offered and why

how the baby develops during pregnancy

what to expect at each stage of the pregnancy

physical and emotional changes during the pregnancy

mental health during the pregnancy

relationship changes during the pregnancy

how the woman and her partner can support each other

immunisation for flu, pertussis (whooping cough) and other infections (for example, COVID‑19) during pregnancy, in line with the NICE guideline on flu vaccination and the Public Health England Green Book on immunisation against infectious disease

infections that can impact on the baby in pregnancy or during birth (such as group B streptococcus, herpes simplex and cytomegalovirus)

reducing the risk of infections, for example, encouraging hand washing

safe use of medicines, health supplements and herbal remedies during pregnancy

resources and support for expectant and new parents

how to get in touch with local or national peer support services.

1.3.9 At the first antenatal (booking) appointment, and later if appropriate, discuss and give information about nutrition and diet, physical activity, smoking cessation and recreational drug use in a non-judgemental, compassionate and personalised way. See the NICE guidelines on maternal and child nutrition , vitamin D , weight management before, during and after pregnancy , smoking: stopping in pregnancy and after childbirth , and the section on pregnant women who misuse substances (alcohol and/or drugs) in the NICE guideline on pregnancy and complex social factors .

1.3.10 At the first antenatal (booking) appointment, and later if appropriate, discuss alcohol consumption and follow the UK Chief Medical Officers' low-risk drinking guidelines . Explain that:

there is no known safe level of alcohol consumption during pregnancy

drinking alcohol during the pregnancy can lead to long-term harm to the baby

the safest approach is to avoid alcohol altogether to minimise risks to the baby.

1.3.11 Throughout the pregnancy, discuss and give information on:

how the parents can bond with their baby and the importance of emotional attachment (also see the section on promoting emotional attachment in the NICE guideline on postnatal care )

the results of any blood or screening tests from previous appointments.

1.3.12 See the NICE guideline on pelvic floor dysfunction for guidance on:

providing information about pelvic floor dysfunction (recommendation 1.1.6)

pelvic floor muscle training during and after pregnancy .

1.3.13 After 24 weeks, discuss babies' movements (see also recommendation 1.2.34 ).

1.3.14 Before 28 weeks, start talking with the woman about her birth preferences and the implications, benefits and risks of different options (see the section on planning place of birth in the NICE guideline on intrapartum care and the section on planning mode of birth in the NICE guideline on caesarean birth ).

1.3.15 After 28 weeks, discuss and give information on:

preparing for labour and birth, including information about coping in labour and creating a birth plan

recognising active labour

the postnatal period, including:

care of the new baby

the baby's feeding

vitamin K prophylaxis

newborn screening

postnatal self-care, including pelvic floor exercises

awareness of mood changes and postnatal mental health. Also see the NICE guideline on postnatal care .

1.3.16 From 28 weeks onwards, as appropriate, continue the discussions and confirm the woman's birth preferences, discussing the implications, benefits and risks of all the options.

1.3.17 From 38 weeks, discuss prolonged pregnancy and options on how to manage this, in line with the NICE guideline on inducing labour .

1.3.18 See the NICE guideline on preterm labour and birth for women at increased risk of, or with symptoms and signs of, preterm labour (before 37 weeks), and women having a planned preterm birth.

1.3.19 Provide appropriate information and support for women whose baby is considered to be at an increased risk of neonatal admission.

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on information about antenatal care .

evidence review A: information provision

evidence review B: approaches to information provision

evidence review C: involving partners

evidence review D: peer support

evidence review G: content of antenatal appointments

evidence review J: referral and delivery of antenatal care

evidence review P: fetal movement monitoring .

Antenatal classes

1.3.20 Offer nulliparous women (and their partners) antenatal classes that include topics such as:

preparing for labour and birth

supporting each other throughout the pregnancy and after birth

common events in labour and birth

how to care for the baby

planning and managing their baby's feeding (also see the section on planning and supporting babies' feeding in the NICE guideline on postnatal care ).

1.3.21 Consider antenatal classes for multiparous women (and their partners) if they could benefit from attending (for example, if they have had a long gap between pregnancies, or have never attended antenatal classes before).

1.3.22 Ensure that antenatal classes are welcoming, accessible and adapted to meet the needs of local communities. Also see the section on young pregnant women aged under 20 in the NICE guideline on pregnancy and complex social factors .

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on antenatal classes .

Full details of the evidence and the committee's discussion are in evidence review E: antenatal classes and evidence review B: approaches to information provision .

Peer support

1.3.23 Discuss the potential benefits of peer support with pregnant women (and their partners), and explain how it may:

provide practical support

help to build confidence

reduce feelings of isolation.

1.3.24 Offer pregnant women (and their partners) information about how to access local and national peer support services.

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on peer support .

Full details of the evidence and the committee's discussion are in evidence review D: peer support .

Sleep position

1.3.25 Advise women to avoid going to sleep on their back after 28 weeks of pregnancy and to consider using pillows, for example, to maintain their position while sleeping.

1.3.26 Explain to the woman that there may be a link between going to sleep on her back and stillbirth in late pregnancy (after 28 weeks).

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on sleep position .

Full details of the evidence and the committee's discussion are in evidence review W: maternal sleep position during pregnancy .

Nausea and vomiting

1.4.1 Reassure women that mild to moderate nausea and vomiting are common in pregnancy, and are likely to resolve before 16 to 20 weeks.

1.4.2 Recognise that by the time women seek advice from healthcare professionals about nausea and vomiting in pregnancy, they may have already tried a number of different interventions.

1.4.3 For pregnant women with mild‑to‑moderate nausea and vomiting who prefer a non-pharmacological option, suggest that they try ginger.

1.4.4 When considering pharmacological treatments for nausea and vomiting in pregnancy, discuss the advantages and disadvantages of different antiemetics with the woman. Take into account her preferences and her experience with treatments in previous pregnancies. See table 1 on the advantages and disadvantages of different pharmacological treatments for nausea and vomiting in pregnancy to support shared decision making .

1.4.5 For pregnant women with nausea and vomiting who choose a pharmacological treatment, offer an antiemetic (see table 1 on the advantages and disadvantages of different pharmacological treatments for nausea and vomiting in pregnancy ).

1.4.6 For pregnant women with moderate‑to‑severe nausea and vomiting:

consider intravenous fluids, ideally on an outpatient basis

consider acupressure as an adjunct treatment.

1.4.7 Consider inpatient care if vomiting is severe and not responding to primary care or outpatient management. This will include women with hyperemesis gravidarum. For more information on managing hyperemesis gravidarum, see the Royal College of Obstetricians and Gynaecologists' guideline on the management of nausea and vomiting of pregnancy and hyperemesis gravidarum . Also see the section on venous thromboembolism .

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on nausea and vomiting .

Full details of the evidence and the committee's discussion are in evidence review R: management of nausea and vomiting in pregnancy .

1.4.8 Give information about lifestyle and dietary changes to pregnant women with heartburn in line with the section on common elements of care in the NICE guideline on gastro-oesophageal reflux disease and dyspepsia in adults .

1.4.9 Consider a trial of an antacid or alginate for pregnant women with heartburn.

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on heartburn .

Full details of the evidence and the committee's discussion are in evidence review S: management of heartburn in pregnancy .

Symptomatic vaginal discharge

1.4.10 Advise pregnant women who have vaginal discharge that this is common during pregnancy, but if it is accompanied by symptoms such as itching, soreness, an unpleasant smell or pain on passing urine, there may be an infection that needs to be investigated and treated.

1.4.11 Consider carrying out a vaginal swab for pregnant women with symptomatic vaginal discharge if there is doubt about the cause.

1.4.12 If a sexually transmitted infection is suspected, consider arranging appropriate investigations.

1.4.13 Offer vaginal imidazole (such as clotrimazole or econazole) to treat vaginal candidiasis in pregnant women.

1.4.14 Consider oral or vaginal antibiotics to treat bacterial vaginosis in pregnant women in line with the NICE guideline on antimicrobial stewardship .

For a short explanation of why the committee made the recommendations and how they might practice, see the rationale and impact section on symptomatic vaginal discharge .

Full details of the evidence and the committee's discussion are in evidence review T: management of symptomatic vaginal discharge in pregnancy .

Pelvic girdle pain

1.4.15 For women with pregnancy-related pelvic girdle pain, consider referral to physiotherapy services for:

exercise advice and/or

a non-rigid lumbopelvic belt.

For a short explanation of why the committee made the recommendation and how it might affect practice, see the rationale and impact section on pelvic girdle pain .

Full details of the evidence and the committee's discussion are in   evidence review U: management of pelvic girdle pain in pregnancy .

Unexplained vaginal bleeding after 13 weeks

1.4.16 Offer anti-D immunoglobulin to women who present with vaginal bleeding after 13 weeks of pregnancy if they are:

rhesus D-negative and

at risk of isoimmunisation.

1.4.17 Refer pregnant women with unexplained vaginal bleeding after 13 weeks to secondary care for a review.

1.4.18 For pregnant women with unexplained vaginal bleeding after 13 weeks, assess whether to admit them to hospital, taking into account:

the risk of placental abruption

the risk of preterm delivery

the extent of vaginal bleeding

the woman's ability to attend secondary care in an emergency.

1.4.19 For pregnant women who present with unexplained vaginal bleeding, offer to carry out placental localisation by ultrasound if the placental site is not known.

1.4.20 For pregnant women with unexplained vaginal bleeding who are admitted to hospital, consider corticosteroids for fetal lung maturation if there is an increased risk of preterm birth within 48 hours. Take into account gestational age (see the section on maternal corticosteroids in the NICE guideline on preterm labour and birth ).

1.4.21 Consider discussing the increased risk of preterm birth with women who have unexplained vaginal bleeding.

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on unexplained vaginal bleeding after 13 weeks .

Full details of the evidence and the committee's discussion are in evidence review V: management of unexplained vaginal bleeding in pregnancy .

This section defines terms that have been used in a particular way for this guideline.

Bonding and emotional attachment

Bonding is the positive emotional and psychological connection that the parent develops with the baby.

Emotional attachment refers to the relationship between the baby and parent, driven by innate behaviour and which ensures the baby's proximity to the parent and safety. Its development is a complex and dynamic process that is dependent on sensitive and emotionally attuned parent interactions supporting healthy infant psychological and social development and a secure attachment. Babies form attachments with a variety of caregivers but the first, and usually most significant of these, will be with the mother and/or father.

Continuity of carer

Having continuity of carer means that a trusting relationship can be developed between the woman and the healthcare professional who cares for her. Better Births , a report by the National Maternity Review, defines continuity of carer as consistency in the midwifery team (between 4 and 8 individuals) that provides care for the woman and her baby throughout pregnancy, labour and the postnatal period. A named midwife coordinates the care and takes responsibility for ensuring that the needs of the woman and her baby are met throughout the antenatal, intrapartum and postnatal periods.

For the purpose of this guideline, definition of continuity of carer in the Better Births report has been adapted to include not just the midwifery team but any healthcare team involved in the care of the woman and her baby. It emphasises the importance of effective information transfer between the individuals within the team. For more information, see the NHS Implementing Better Births: continuity of carer .

Partner refers to the woman's chosen supporter. This could be the baby's father, the woman's partner, family member or friend, or anyone who the woman feels supported by and wishes to involve in her antenatal care.

Shared decision making

Shared decision making is a collaborative process that involves a person and their healthcare professional working together to reach a joint decision about care. It could be care the person needs straightaway or care in the future, for example, through advance care planning. See the full definition in the NICE guideline on shared decision making . In line with  NHS England's personalised care and support planning guidance: guidance for local maternity systems , in maternity services, this may be referred to as 'informed decision making'.

Structured fetal movement awareness packages

The structured fetal movement awareness package described in the Awareness of fetal movements and care package to reduce fetal mortality (AFFIRM) trial consisted of:

an e-learning education package for all clinical staff about the importance of a recent change in the frequency of fetal movements and how to manage reduced fetal movements

a leaflet given to pregnant women at 20 weeks of pregnancy to raise awareness of the importance of monitoring fetal movements and reporting reduced movements

a structured management plan for hospitals following reporting of reduction in fetal movement including cardiotocography, measurement of liquor volume and a growth scan (umbilical artery doppler was encouraged if available).

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What does a midwife do and other FAQs

Read time 6 minutes

They’ll be one of the most important people in your life for nine months (and beyond). So here’s what you need to know about your midwife’s role.

What is a midwife?

A midwife is a health professional (male or female) who supports women through pregnancy, labour, birth and the early days of parenthood (MIDIRS, 2017) . They will see you through scans, tests and welcoming your baby into the world.

What does a midwife do?

A midwife can be based in hospital, in a community setting like a midwife-led unit or a doctor’s surgery, or they can visit you at home (MIDIRS, 2017) . Community midwives will monitor you during your pregnancy, give advice and arrange access to any medical care you need.

For the birth, a hospital midwife will support and guide you and help you to get medical support if you need it. After your baby is born, a community midwife will be around to help you feed and care for your baby. That is, until you’re ready to say goodbye to them and switch over to a health visitor.

Do I have to see my GP for a referral to a midwife?

No, it’s much simpler than that – you can go directly to a midwife for your antenatal care (NICE, 2008) . Your GP practice or health centre can give you contact details for an NHS midwife. Your local NHS Hospital Trust website might also contain NHS midwives’ contact details.

"You don’t have to see a GP or an obstetrician while you’re pregnant or giving birth if you’d prefer not to, as long there are no complications (NICE, 2008) ."

Can I choose a private midwife, rather than NHS?

Of course, if you’re happy to pay. Independent midwives work for themselves so they charge for their services (IMUK, 2014a) .

If you opt for this route the same midwife – possibly with a colleague – will care for you throughout. This can improve a woman’s chance of achieving the kind of birth she is aiming for (IMUK, 2014b) . Independent midwives are often very experienced in more complicated births, such as vaginal breech, twin, and after caesarean (VBAC ) births too (IMUK, 2014b) .

Many women who choose indpendent midwives plump for a home birth but it’s not restricted: you are still able to access NHS care if it’s needed (IMUK, 2014c) . Find out how to access an independent midwife at IMUK  or the Positive Birth Movement  or go for a personal recommendation from a friend.

Is a doula the same as a midwife?

No. You might have heard mention of doulas but have never been quite sure how they’re different from midwives. The main distinction is that they are not acting medically but as a person who supports you during labour, birth and postnatally (Doula UK, 2017) .

What happens at my midwife appointments?

If this is your first baby you’ll probably have 10 appointments, but if you already have children it will likely drop down to seven (NICE, 2008) . You might have extra appointments if you see a specialist; if so, this should be written in your maternity notes that you’ll get at your ‘booking’ (first) appointment (NICE, 2008) . Here’s what to expect:

• You’ll have your ‘booking’ appointment between eight to 12 weeks of pregnancy.
• At each appointment, you’ll have specific topics to talk through. This will include things like which screening and antenatal tests are available, your lifestyle or what type of birth you’d like. You’ll always be given the chance to ask questions.
• At every appointment, your midwife will ask permission to take your blood pressure and check your urine for glucose and protein.
• Your midwife will feel your tummy to see how your baby is growing, and listen to your baby’s heartbeat. Towards the end of your pregnancy, they’ll also ask about their activity and check which position your baby is in.

(NHS, 2015)

Do I call my midwife when I go into labour?

The process on the big day varies throughout the country, so talk to your midwife about what happens in your area. Your local NHS Hospital Trust  might also provide details. Some areas have a single telephone number to call when you’re in labour, where you speak to a midwife and discuss what to do.

Whether you’re having your baby at home, a midwife-led unit or an obstetric unit, the midwife will support you and liaise with medical staff if needed (NICE, 2014) . Straight after the birth, your midwife will check you both over and offer help with feeding and stitches if needed. They might also refer you on to further medical support if you need it (NICE, 2006, 2014) .

Will I see the midwife after my baby is born?

Technically, your midwife will continue to support you for six to eight weeks  after you welcome your baby into the world and will also make sure you’re both adjusting well (Raynor, 2017) . If you’re doing ok though, you’re more likely to move over to the care of a health visitor around day ten. Check your maternity notes or ask your midwife to find out how and when the transition works in your area.

This page was last reviewed in September 2017.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer  antenatal courses  which are a great way to find out more about having a baby, labour and life with a new child.

For more information on everything that midwives do, check out the Nursing and Midwifery Council  or the Royal College of Midwives

Doula UK (2017) About doulas. Available at: https://doula.org.uk/about-doulas/ [Accessed 12th September 2017].

IMUK (2014a) FAQs. http://www.imuk.org.uk/professionals/faqs/#about [Accessed 6th September 2017].

IMUK (2014b) What we do. http://www.imuk.org.uk/families/what-we-do/ [Accessed 6th September 2017].

IMUK (2014c) Hospital birth and NHS care. http://www.imuk.org.uk/families/faqs/#hospital [Accessed 12th September 2017].

MIDIRS (2017) Definition of the midwife. https://www.midirs.org/how-to-become-a-midwife/definition-midwife/ [Accessed 10th August 2017].

NHS (2015) Your antenatal care. Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/pages/antenatal-midwife… [Accessed 10th August 2017].

NICE (2006) Postnatal care up to 8 weeks after birth CG37. https://www.nice.org.uk/guidance/cg37 [Accessed 6th September 2017].

NICE (2008) Antenatal care for uncomplicated pregnancies. https://www.nice.org.uk/guidance/cg62 [Accessed 10th August 2017].

NICE (2014) Intrapartum care for healthy women and babies CG 190 https://www.nice.org.uk/guidance/cg190 [Accessed 6th September 2017].

Raynor MD (2017) Myles survival guide to midwifery Ebook. Available at: https://books.google.co.uk/books [Accessed 12th September 2017].

Further reading

Department of Health (2014) Independent midwives: insurance options outlined. Available at: https://www.gov.uk/government/news/independent-midwives-insurance-optio… [Accessed 6th September 2017].

MIDIRS (2017) Midwifery education: academic and clinical course content. Available at: https://www.midirs.org/how-to-become-a-midwife/midwifery-education-acad… [Accessed 6th September 2017].

NMC (2015) The Code. Available at: https://www.nmc.org.uk/standards/code/ [Accessed 6th September 2017].

NMC (2017) Standards for competence for registered midwives. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/standards/nmc-standar… 6th September 2017].

RCM (2018) Independent midwives FAQs. Available at: https://www.rcm.org.uk/content/independent-midwives-faqa [Accessed 5th March 2018].

Information you can trust from NCT

When it comes to content, our aim is simple: every parent should have access to information they can trust.

All of our articles have been thoroughly researched and are based on the latest evidence from reputable and robust sources. We create our articles with NCT antenatal teachers, postnatal leaders and breastfeeding counsellors, as well as academics and representatives from relevant organisations and charities.

Read more about our editorial review process .

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Preplanned tours

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One Day Tour of Moscow

This one day tour gives an excellent overview of Moscow, its past and present and its main attractions. It includes a visit to the Kremlin, a 4-hour walking tour and a Moscow Metro tour. See more

Duration: 6-7 hours

Cost: 240 USD per group + 20 USD per person (including the guide) for the Kremlin tickets

NB. The number of tickets to the Kremlin is limited. Please book this tour in advance. The Kremlin is closed on Thursday.

One Day Tour Delux

This day tour allows to see the most of Moscow attractions in one day! This tour is extremely rich with sights. It includes a visit to the Kremlin, the Armoury, the Diamond Fund and the city tour by car. See more

300 USD + 55 USD per person (including the guide) for the tickets to the Kremlin, the Armory

Two days tour of Moscow

A guided visit to the Kremlin, the Armoury, Tretyakov Art Gallery and Moscow Metro as well as a well-rounded tour of the city center are waiting for you! The guide will help you to get a good understanding of Russian history, culture and art during the Two days tour. See more

2 days, 6-7 hours every day

480 USD per group + 55 USD per person (including the guide) for the Kremlin and the Armory Chamber tickets.

NB. The number of tickets to the Kremlin is limited. Please book this tour in advance.

Two days Tour Delux

The tour includes all the best Moscow has to offer! It combines a walking tour of the city center (Red Square and surroundings) with Metro tour and visits to the best museums of Moscow: the Kremlin, the Armoury, the Diamond Fund and the Tretyakov Art Gallery. A city tour by car allows you to see the sights scattered around Moscow! See more

540 USD for 1-2 people, 570 USD for 3-5 people + 55 USD per person (including the guide) for the tickets to the Kremlin and the Armoury.

Three days tour of Moscow

This tour is our best-seller! In addition to the main touristic sights it includes a countryside trip to Sergiev Posad - the greatest spiritual center of the country, where you can also observe life of common people and enjoy beautiful landscapes. In these three days you will get an expertise in Russian history, culture, art and religion! See more

3 days, 6-7 hours

Tour price: 940 USD for 1-2 people, 1050 USD for 3-5 people + 75 USD per person (including the guide) for all tickets NB. The number of tickets to the Kremlin is limited. Please book this tour in advance.

1/2 day. Panoramic city tour by car

This Moscow city tour covers all main Moscow attractions and is perfect for the visitors who want to get an idea of what the city has to offer before starting to explore it by themselves. The tour price includes transportation by car or minivan. See more

from 240 USD

1/2 day. Walking tour of central Moscow

You will walk across famous Red Square, will see the walls and the towers of the Kremlin. Accompanied by a fully-licensed guide, you can visit the two main Moscow cathedrals - St. Basil's and Christ the Saviour and a marvelous 19th century shopping mall - GUM. The route is 5-6 km length. At the end of the tour the guide can show you a couple of the most beautiful Moscow metro stations. See more

1/2 day. Red square and The Kremlin

Visit the two most iconic parts of Moscow, even the whole of Russia with a professional guide, speaking your language! See more

120 USD per group + 20 USD per person (including the guide) for the Kremlin tickets

NB. The number of tickets to the Kremlin is limited. Please book this tour in advance. The Kremlin is closed on Thursdays.

1/2 day. The Kremlin and the Armoury

This tour takes you to the very heart of Russia, the Kremlin. After walking around its grounds, talking about its past and present and visiting its magnificent cathedrals, we visit the fabulous Armoury Chamber, which houses precious items preserved for centuries in the Tzars’ Treasury. See more

120 USD per group + 55 USD per person (including a guide) for the Kremlin and the Armory Chamber tickets

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Planning a trip to Moscow? Our travel guide contains up-to-date, personal information on everything from what to see , to when to visit , where to stay , and what to eat !

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Why visit Moscow?

Majestic churches, impressive historic fortresses, and palatial buildings: Moscow is a fascinating city whose emblematic architecture reflects the turbulent history that has defined Russia throughout the centuries.

The traces of the USSR can be found around every corner of the city , side by side with the iconic relics of Imperial Russia , like the mythical Red Square , the imposing Kremlin , and the beautiful  St Basil's Cathedral . 

Discover a fascinating world of Cold War bunkers, golden-domed basilicas, world-class art museums, and the legendary "palace of the people,"  as the Moscow Metro has been nicknamed. Whether you fancy watching a classical Russian ballet at the Bolshoi Theatre , perusing the fine arts at the Pushkin Museum , or marveling at the sheer size of the monuments to the Soviet state's achievements at the  All-Russia Exhibition Centre , this travel guide will help you on your way!

Where to start?

If you're going to travel to Moscow and you don't know much about the city yet, the first thing to do is to dive into its legendary history - understanding the past will help you understand the present. Next, check out our practical hints and tips on traveling to the city before discovering which of its most important museums , monuments , and attractions pique your interest.

Looking for a place to stay?

Booking your accommodation in advance is the best way to get great discounts. Our detailed guide on where to stay in Moscow  will help you decide which neighborhood you'd like to look for hotels or apartments in, and our hotel search engine will find you the best deals!

Why is our Moscow travel guide the best?

Introducing Moscow is a  city guide written by travelers for travelers  and contains personalized advice to help you make the most of your trip to the city.

All the information in this guide is valid as of December 2022. If you find any errors or have any comments, please feel free to contact us .

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Free Comic Book Day 2024 Guide: 21 stores in Northeast Ohio you can visit this year

• Published: Apr. 30, 2024, 6:02 a.m.

• Mike Rose, cleveland.com

CLEVELAND, Ohio - Traditionally taking place the first Saturday in May, Free Comic Book Day returns this weekend on May 4. Comic book shops and other participating stores and venues will be offering special free comics, sales and other events throughout the day. This year happens to coincide with Star Wars Day and several of the locations listed below will have activities taking place to honor both events.

Check out our list of more than 20 locations in Northeast Ohio that are participating in the promotion this year. Please note some shops may have additional restrictions on books early in the day and some locations do not carry every title available on Free Comic Book Day 2024 .

Cleveland and western suburbs

Carol and John’s Comics Book Shop

17462 Lorain Ave, Cleveland. 216-252-0606

10 a.m. - 7 p.m.

Each purchase in the shop will also receive a free promotional poster honoring old Marvel Star Wars comics. Designer Jameson Campbell will be signing copies of the print from 10 a.m. until noon. Back issues in the shop will be on sale 50% off all day.

Please note: The Free Comic Book Room will be moving to a new spot this year (17480 Lorain Ave.), only 50 feet from the shop.

Twenty artists and vendors will be selling artwork and products throughout the day in the Free Comic Book Room. In addition, watch live as The Rust Belt Monster Collective creates a mural also featuring a theme of early-Marvel Star Wars. Bluey will also be available to pose for pictures. Each guest may pick out 12 books from the 48 titles being offered.

Comics are Go!

5214 Detroit Rd, Sheffield; 440-695-8401

11 a.m. - 8 p.m.

Offering the full selection of Free Comic Book Day books from Marvel, DC, and the major independent publishers. We will also be joined by fan and shop favorite, Rick Lozano, co-creator of “American Knight” and the graphic designer for NEO ComicCon. Rick will do sketches and take commissions. Additionally, this year (weather permitting), there will be a sidewalk sale with over 100 boxes of $1 comics.

Ground Zero Comics

15139 Pearl Rd, Strongsville; 440-572-9599

11 a.m. - 10 p.m.

20% off trade paperbacks and graphic novels; Limit of 5 free books per guest.

Keith’s Comics

394 Broad St, Elyria; 440-323-2000

11:30 a.m. - 7:30 p.m.

Local artist Al Sharp will be doing free sketches. Artist Richard Hooper will be doing free caricatures as well. Free books will be available while supplies last. Limit of 3 books per guest.

Kidforce Collectibles

103 Front St, Berea; 440-239-7777

11 a.m. - 6 p.m.

In addition to free comics, there will also be a sale of comic-related items throughout the store including action figures, graphic novels, posters and more.

North Coast Nostalgia

5853 Ridge Rd, Parma; 440-845-7040

11:00 a.m. - 6 p.m.

All back issues originally priced at $3 or less will only be $1. Trades and hard covers will be 20% and the store will also have themed baskets that will be raffled off. Local artist Jason Dunbar will also be at the store selling his original artwork. 3 free titles per guest, while supplies last.

Superscript Comics and Games

13361 Madison Ave, Lakewood; 216-712-6231

11 a.m. - 9 p.m. on Saturday; special hours Friday night (see details below)

Festivities begin Friday night at 6:30 p.m. at Bottlehouse Lakewood. Superscript will host Enthusiast Trivia starting at 9 p.m. The evening concludes with a midnight opening at Superscript (until 2 a.m.) featuring over 40 free books to choose from. Limit of 8 books per guest.

The shop will then reopen at 11 a.m. Saturday with more activities throughout the day. There will also be a sale on back issues, graphic novels and more.

Superscript, Lakewood Art Supply, Lemon Seeds Music and Magically Found will be hosting local comic creators and artists from 11 a.m. - 6 p.m. Saturday.

All purchases made at Superscript Tuesday through Saturday will enter guests in a raffle for a chance at comics, games and baskets from local businesses. Drawings will be held at the store throughout the day Saturday starting at 2 p.m.

Eastern suburbs

Comic Heaven

48474 Robinhood Dr, Willoughby; 440-942-6960

Noon - 6 p.m.

Free comics available for all guests. Back issues will be on sale 30% off throughout the day and various cosplayers will be visiting as well.

Comics and Friends

7850 Mentor Ave, Suite 1054, Mentor; 440-255-4242

Doors at 11 a.m.

Free books will be available while supplies last. The following local guests will be stopping by as well: Chris Lambert, Paul Ferris, McKenna Nalow, Scott Wilson, Jason Bascom and Anna Kopp.

23 W Main St, Geneva; 440-415-1228

10 a.m. - 4 p.m.

A slate of free comics will be available. Please contact the store for additional details.

Vallar Comics

29135 Euclid Ave, Wickliffe; 440-278-4007

10 a.m. - 6 p.m.

All trade paperbacks, toys, action figures and statues will all be 20% off. Limit of 8 free books per guest and only 1 copy of any individual title.

Akron/Canton and southern suburbs

Bill’s Books & More

2215 6th St SW, Canton; 330-453-3996

11 a.m. - 7 p.m.

Multiple sales and specials taking place all day including select $1 back issues, $2 posters, 25% off action figures, statues and toys, 50% of hardcovers and trade paperbacks and more.

Guest artists include Darryl Banks, Brandon Franklin and Landon Franklin who will be doing sketches and signings.

Comics, Cards and Collectibles

724 Cleveland Ave SW, Canton; 330-456-8907

Over 40,000 back issues are on sale for $1 each. Select action figures, DVDs, trade paperbacks, posters, graphic novels and many other items in the store will also be on sale. Limit 3 free books per guest.

Hazel’s Heroes Comics & More

1664 N Main St, North Canton; 330-244-9988

10 a.m. - 5 p.m.

Storewide sale all day. Guest artist Rodney Fike will be in-store. Limit 5 books per guest.

JC Comics and Cards

2609 State Rd, Cuyahoga Falls; 330-929-1929

A storewide sale will be taking place throughout the day. Early guests may see a limit of 8 books depending on demand. Additional businesses in the plaza will also be offering FCBD deals to guests.

Johnny Scott Comics & Games

1703 E. Main St, Kent; 330-474-7049

Each guest may help themselves to one copy of each book on the FCBD tables. In addition, the store will be running its third annual back-issue sale. All back issues will be on sale 20% off.

Kenmore Komics

1020 Kenmore Blvd, Akron; 330-745-5530

11 a.m. - 3 p.m.

Five free comics per guest. Customers who make a purchase may select an additional five books. The store will also be having a big sale on back issues of comics.

Magic City Comics

528 W. Tuscarawas Ave, Barberton; 330-575-5579

Sale with discounts on comics throughout the day. Local artists Twan Amato and Chris Kasmar will be at the store signing books and doing sketches.

Rubber City Comics

74 E. Mill St, Akron; 330-548-5992

In addition to free comics, special sales will be taking place throughout the day. Contact the store for more details.

Sweets & Geeks

342 E. Smith Road, Medina; 330-662-4272

10 a.m. - 9 p.m.

All comics-related, Star Wars and superhero merchandise is discounted 15% (LEGO excluded).

Meet Tony Isabella, creator of Black Lightning and enjoy food from the E.O.D. food truck. The Infinity Gauntlet and Infinity Stones will be hidden throughout the store. Snap photos of them to win a prize. All guests can choose five free books from the more than 30 available.

The Toys Time Forgot

137 Cherry St E, Canal Fulton; 330-854-1700

Store open 10 a.m. - 7 p.m.

Featuring a street fair atmosphere, the day includes face paintings, live DJ, Feel Good BBQ food truck, custom pop culture apparel from Meanwhile... The Toy Place, cosplayers, raffles, thousands of free comics & much more. Outdoor festivities run 10 a.m. - 5 p.m.

Special guests for the day include Philbee the Clown, Pop Artist Ed Griffie, Shana Schottenstein and Randel from Shottsy Arts, and Ohio Championship Wrestler “No Shame” Jimmy Shane. Saturday is also the final day of the store’s annual Spring Super Sale with 20% off nearly every toy and collectible in the store, and 30% off Funko Pops and regular back issue comic books. Limit of 10 free comics per person while supplies last.

Additional Free Comic Book Day coverage

Rocky River Public Library will be offering free books (while supplies last) and will have crafting and other activities taking place. Library hours are 9 a.m. - 6 p.m. on Saturday.

Westlake’s Porter Library will also be taking part in the day’s festivities, offering free books to patrons (while supplies last). Guests will have the chance to make their own comic book and learn how to make stickers (10 a.m. - 2 p.m.). A member of the Ohio Star Wars Costume Legions will be on site from 1-3 p.m. for selfies and cartoon and comic creations by local artist Mel Maurer will be on display all day. Library hours are 9 a.m. - 6 p.m. on Saturday.

Multiple branches of the Cuyahoga County Public Library will also be offering free books while supplies last including the Parma-Snow (9 a.m. -5:30 p.m.), Parma-Powers (9 a.m. -5:30 p.m.) and Brooklyn (11 a.m. - 2 p.m.) locations. The Brooklyn location will also feature costumed characters and R2-D2 for photos.

Is your store missing from our list? Please e-mail [email protected] with your store info and event details.

Check out our gallery of photos from Free Comic Book Day 2022 .

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South Dakota Gov. Kristi Noem defends her account of killing own dog in new book

South Dakota governor and Republican vice presidential contender Kristi Noem on Friday responded to a news report about a section of her forthcoming book where she describes killing her 14-month-old dog.

“We love animals, but tough decisions like this happen all the time on a farm,” she said in a post to X above a headline from The Guardian , which obtained a copy of Noem's upcoming book, “No Going Back.”

The Guardian's article describes a section of Noem's book, set for release next month, in which she recounted shooting her dog after deciding it was “less than worthless” and “untrainable.”

In her account, Noem grabbed her gun and led the dog, named Cricket, to a gravel pit.

“It was not a pleasant job, but it had to be done. And after it was over, I realized another unpleasant job needed to be done,” Noem wrote.

She then went on to kill a family goat, which she called “nasty and mean.” Noem also led the goat to a gravel pit, where she said her first shot wounded but did not kill the animal. She got another shell for her gun and killed the goat, according to the book.

Noem wrote that her daughter seemed confused when she came home from school, asking, “Hey, where's Cricket?”

NBC News has not obtained Noem's book or independently verified the section reported by The Guardian.

Noem was lambasted Friday on social media; some said they were “ horrified ,” while others posted pictures of their dogs .

The Biden campaign p osted p hotos of the president walking with the family dog Commander, who has had numerous biting incidents , and Vice President Kamala Harris cuddling a dog.

Noem is widely viewed as a top contender to be Trump's running mate. She is in her second term as South Dakota governor, and she previously served as the state's lone representative in the U.S. House.

Megan Lebowitz is a politics reporter for NBC News.

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Did Richard III Kill the Princes in the Tower?

Philippa Langley devoted years to the search for Richard III’s remains. Now, she’s trying to crack a 15th-century cold case: Did he really assassinate his nephews?

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By Amelia Nierenberg

Reporting from Edinburgh and the Tower of London.

For over 400 years, Richard III has been seen as Britain’s most infamous king — a power-hungry usurper who killed his young nephews to clear the way to the throne.

In Shakespeare’s “Richard III,” the king tells an assassin, “I wish the bastards dead,” referring to the princes Edward V and Richard. “And I would have it suddenly performed.”

But the king’s murderous image, drawn from history books and cemented in literature and lore, is just not true — or, at least, it has not been proven true, argues Philippa Langley, an author and independent historian.

“Maybe there is evidence,” she said over a cup of tea in Edinburgh earlier this year. “But there seems to be no evidence.”

Langley is, perhaps, Richard III’s most dedicated living defender. A prominent member of the Richard III Society , an organization that has been working since 1924 “to secure a more balanced assessment of the king,” she has made a career of researching — and rehabilitating — a man who ruled for two years, from 1483 to his death in 1485.

In 2012, she spearheaded a project to find his remains , which were under a parking lot in the city of Leicester, as she believed they would be, and give him a dignified burial. Once she had laid Richard III to rest, however, she found she couldn’t quite let him go. After all, he was still seen as a murderer.

So she took on the case of the princes’ disappearance . Is there, she wanted to know, enough archival evidence to say beyond a reasonable doubt that Richard III ordered the assassinations of the boys? Was the king a murderer — or a victim of centuries of rumor and prejudice?

These are the questions at the heart of Langley’s most recent book, “ The Princes in the Tower ,” published in late 2023. In it, she takes a true-crime approach to the mystery, using what she describes as “the same principles and practices as a modern police inquiry.”

She wanted to find the truth, she said, even if it meant finding evidence that suggests that he was, indeed, a killer.

“It’s about making sure that the story we tell about this country is correct,” Langley, 62, said, adding, “Whether that is today or tomorrow or 500 years ago, evidence, truth, facts — rather than stories and lies — are really important.”

To the reading public in Britain and historians around the world, Langley is something of a curiosity. She did not attend university. And yet she became the face of one of the splashiest historical events of the century.

For finding Richard III’s body, she was awarded an M.B.E. , a national honor. She is recognized at train stations, though not terribly often, she said. And she has earned the respect of many university scholars.

“I don’t think she got lucky with Richard III,” said Sebastian Sobecki, a professor of late medieval English literature at the University of Toronto. “She did very good research.”

He is one of many academics who acknowledge that Langley, who formerly worked in marketing and advertising, understands how to excite people about the past — more so, perhaps, than most academics (How many historians can say they were played by Sally Hawkins , as Langley was in the film “The Lost King”?)

But even if some professors think of her work as worthy, many also see it as fundamentally unacademic. Serious scholars do not usually probe the past to find or exonerate long-dead kings, they argue.

“The reason that archaeologists hadn’t looked for him in the past is that archaeologists don’t go looking for famous dead people,” said Philip Schwyzer, a specialist in early modern English literature at the University of Exeter.

A few critics even see Langley as a charlatan. But most just think that she is naïve, blinded by her own rosy image of the king.

That outlook builds on a longstanding skepticism of the Richard III Society. “It is frankly partisan in a war that ended more than 500 years ago,” said Spencer A. Strub, a humanities researcher at Princeton University, of the organization.

Langley knows what her detractors say about her, she said: She doesn’t have the right credentials. She’s emotional, a woman with a 15th-century crush.

But Langley fought for legitimacy well before discovering Richard III. For decades, she has lived with chronic fatigue syndrome , a condition that has long been met with skepticism from doctors and colleagues alike.

That’s part of what binds her to Richard III, Langley said. Studies of his skeleton showed that he had scoliosis — a physical condition long portrayed (and mocked ) on the stage as a motivation for his rage across the centuries. “He would have been dealing with something that he had to hide,” she said. “And I was the same.”

And her work speaks for itself, Langley said: She did find his grave. And now, she thinks she has cracked a major historical cover-up.

The story stems from Richard III’s coronation, which happened amid a swirl of scandal.

His brother, King Edward IV, had died in the spring of 1483. Richard was made protector of the realm until the king’s eldest son and successor, the 12-year-old Edward V, came of age. But before the boy was crowned, his parents’ marriage was declared illegitimate and his coronation was suspended.

Richard III was proclaimed king instead. Soon after, the boy and his younger brother, Richard, 9, disappeared from where they had been held, the Tower of London.

That, Langley argues, makes it a missing persons inquest, not a murder case. “This was all we knew for certain, based on the available evidence,” she writes.

She argues that the dominant narrative — that Richard III had the princes killed to take the throne — is little more than rumor that calcified into fact over 500 years. Instead, she suggests, the boys were alive when Richard was crowned.

Richard III was the last king in England’s Plantagenet line. Henry VII, who ousted him, was the first Tudor king; he had a dynasty to establish, a reputation to build. So, Langley argues, Henry VII cast his predecessor as a villain.

It would also have been useful for the Tudors if people thought the boys were dead, unable to fight for the throne, Langley writes in the book. Rumors of their deaths started under Henry VII, she notes, pointing to texts from Richard III’s reign that talk about his nephews in the present tense.

That’s why she thinks that the boys weren’t killed — at least not in the Tower of London, in 1483. Instead, she argues, they were smuggled out of the British capital. Then, after Richard III was killed and the princes were made legitimate again, she argues that they both tried to retake the throne, Anastasia-like .

She weaves her argument out of archival material gathered over seven years by a team of over 300 independent researchers . The evidence includes receipts for weapons; a witness statement describing the boys’ flight; royal seals and more. To complicate matters, Langley also argues that both of the princes were later given false identities by the Tudor government : They were described as impostors trying to pose as princes, not the real thing.

“Apparent red herrings seemed to litter the story,” she writes. “The project could not afford to miss anything, no matter how seemingly insignificant.”

Langley also tries to debunk some of the historically accepted pieces of evidence in support of the view that the nephews were assassinated, the so-called eyewitness testimonies. One, from Sir Thomas More, was written decades after the fact — under the Tudors. She argues that another, penned by an Italian monk who was in London in 1483, does not say the boys were murdered — only that he didn’t know what had happened to the older boy.

The accounts are not proof, she says.

Many top academics agree that the often cited accounts for the princes’ murder are thin. “People realize how flimsy the evidence is,” said Schwyzer, the scholar of early modern English literature. “The most reliable reports say they went into the tower and were seen less and less often, and people thought they were dead.”

For Langley’s argument to prevail, she must first explain the skeletons of young children that were found in the tower in 1674. The bones were examined in 1933. They are interred at Westminster Abbey as the supposed remains of the princes.

“How many children would have been put in a box and buried under a staircase in the tower?” said Raluca Radulescu, a professor of medieval literature and a cultural historian at the University of Bangor, in Wales. “Like, why?”

Langley has an answer there, too.

The remains have not undergone modern scientific analysis or DNA testing, she notes. That would require approval by the Dean of Westminster in consultation with the royal household.

“The view of previous deans has always been that the mortal remains of two young children, widely believed since the 17th century to be the princes in the tower, should not be disturbed,” said Victoria Ribbans, a spokeswoman for the Abbey. “There are no current plans to change this.”

Within the Tower of London itself, speculation is afoot.

Julian Jennings, a warden who has worked there for over 18 years, is fascinated by the history he protects. He even traveled to Leicester when Richard III was reinterred in 2015 , just to be present.

He’s been following the debate about Langley’s book, and he’s bursting to talk about it. When asked for directions — with no mention of the princes — he brought up the debate. “It’s an absolute minefield,” he said.

Jennings is still making up his mind on the matter, he said. But a few stories below, the longstanding narrative is codified on a plaque : “The tradition of the tower has always pointed out this as the stair under which the bones of Edward the 5th and his brother were found.”

The research Langley put forward, he said, could well be the biggest historical shake-up in a long time. He and his colleagues are abuzz with wonder: What if the princes actually lived?

The question is a testament to Langley’s influence.

“It’s good to keep an open mind,” he said, during a recent shift. “At least I do, anyway.”

Amelia Nierenberg writes the Asia Pacific Morning Briefing , a global newsletter. More about Amelia Nierenberg