Pregnancy is always associated with major physical and emotional changes. Pregnancy check-ups accompany the pregnant woman and are designed to identify and, if possible, treat any problems and risks at an early stage.
Fortunately, around 97% of babies in Germany are born healthy. For the best possible safety and health of mother and child, every pregnant woman is legally entitled to regular and free preventive medical check-ups in the nine months leading up to birth.
The details of the examination plan are regulated by the Maternity protection guidelines of the Joint Federal Committee of Doctors and Health Insurance Funds (G-BA). It also stipulates: "The primary aim of prenatal care is the early detection of High-risk pregnancies and high-risk births."
Regular check-ups are scheduled every four weeks - and even every fortnight from the 32nd week of pregnancy. If the expected date of birth has already passed, you will be called into your midwife's or gynaecologist's practice every two days. We midwives can and are also authorised to carry out most check-ups, including the "official" determination of pregnancy. However, ultrasound examinations, for example, are the sole responsibility of a doctor. If you would like to find out more about our midwifery work, please read here continue.
The costs for the preventive services in accordance with the maternity guidelines are covered by the health insurance companies or, if necessary, the social welfare office. In addition to these examinations, you will also be offered certain voluntary services, which you will have to pay for yourself. These are the so-called IGeL services (individual health services). Some health insurance companies also offer additional "packages" for their pregnant policyholders, which include a limited budget for freely selectable additional preventive services (so-called statutory services). The best way to find out about this is to contact your health insurance company directly.
If there are indications for examinations that go beyond the scheduled preventive care, these are also paid for by the health insurance company. For example, if a toxoplasmosis infection is suspected, the insurance company will also cover the costs of the corresponding test. However, if the pregnant woman requests such a test without any reason or indication, she must bear the costs of the test herself.
Tip: Incidentally, if a preventive care appointment falls within your working hours, your employer must give you time off without loss of earnings.
The standard programme
Certain examinations or tests are scheduled at every antenatal appointment. Some also depend on the timing of the pregnancy. Others are a regular part of every antenatal appointment and are therefore carried out again and again. In this way, your doctor or midwife can obtain information about certain irregularities or possible illnesses in the mother and/or child and, if necessary, arrange appropriate treatment as early as possible.
The recurring examinations include
Measure blood pressure: If your blood pressure is (much) too high, this may be an indication of certain illnesses during pregnancy, such as a Pre-eclampsia. The expectant mother's blood pressure should not be higher than 140/90 mmHg. If it is (very) low (less than 100/60 mmHg), the woman may feel tired and listless, possibly in conjunction with dizziness. It will then be investigated whether it is "only" the blood pressure that is to blame or whether there may be other causes.
Weighing: It is important to check the pregnant woman's body weight regularly. How much and how quickly she gains weight gives an indication of the baby's care and development as well as the mother's state of health. If, for example, she gains a conspicuous amount of weight, this may be a sign of Gestational diabetes be. Conversely, if she is gaining very little or too little weight, it is checked whether the baby is sufficiently nourished.
Urinalysis: You will regularly be asked to provide a urine sample at the practice, which will be analysed on the spot. If the sample contains too much sugar, protein or bacteria, for example, this can also be a sign of illnesses such as gestational diabetes or pre-eclampsia.
Blood test: The examination of a blood sample from the pregnant woman's arm vein provides a lot of information, including information on diseases such as hepatitis B, whether antibodies have been produced that could be dangerous for the unborn child or whether gestational diabetes has developed. If an HIV test is carried out, this is noted in the maternity record - however, only you and the doctor or midwife who ordered the test will know the result. This is to prevent pregnant women from being stigmatised if the test result is positive.
What exactly your blood is tested for depends on what is necessary and what has been agreed with you. This means that your blood sample can be analysed for different factors depending on the occasion. For example, the Hb value, i.e. the iron that is built into your red blood cells and transports oxygen in your body, is often checked. The blood test to detect a trisomy, such as Down's syndrome, on the other hand, is none Standard test. It is only covered by health insurance under very specific conditions, otherwise the pregnant woman bears the costs herself.
Checking the uterine position: This can be used to determine how far the uterus has expanded and grown so far. This in turn allows you to indirectly recognise whether the baby is developing as planned. To do this, your midwife or doctor will feel the upper edge of the uterus, the so-called fundus, through the abdominal wall. The further the uterus grows, the further the fundus moves towards the ribs. The distance between the fundus and the pubic bone, navel or ribs is therefore also referred to as the fundal position.
Control of the child's cardiac actions: Your baby's heartbeat is checked regularly - either with a portable device (Dopton) or later via a CTG (cardiotocography). The baby's heart rate provides important information about the baby's well-being and shows whether it is being well cared for. The CTG plays a particularly important role towards the end of the pregnancy, as it also records any contractions.
Determining the position of the child: The position of the baby in the womb is also checked repeatedly. Your midwife or doctor will feel through the abdominal wall to see whether the baby is lying head down (cephalic position) - the ideal position for a natural birth.
Schedule overview
I would like to emphasise at this point: The following overview of the individual screening dates describes the Standard case the scheduled examinations or tests. If there are any indications of irregularities in you or your baby, your gynaecologist or midwife will arrange additional appointments, examinations or referrals as necessary. The well-being of mother and child always comes first.
1st check-up (approx. 5th to 8th week)
Your doctor or midwife has "officially" established that you are pregnant at this appointment. Congratulations! Maybe you already had a hunch or a positive pregnancy test from the pharmacy, or maybe you were simply surprised by this news. Now the Expected date of birth calculatedand your Maternity passport issued and handed over to you. From now on, all the results of your pregnancy will be entered in this blue booklet, including those of the first examinations on that day. From now on, always carry this booklet with you just in case!
At this appointment, your urine will not only be analysed for sugar and protein, but also for bacteria (e.g. chlamydia). The blood sample will also be used to determine your blood group, rhesus factor and the presence of antibodies against rubella. In addition, an HIV test may be carried out in order to reduce the probability of transmission to the child through targeted therapeutic measures in the event of an existing infection.
A hepatitis B test is also carried out as early as possible in the pregnancy. If the result is positive, appropriate treatment is given during pregnancy. The child also receives a hepatitis B vaccination immediately after birth.
The doctor or midwife will also take your medical history and ask about any complaints and previous pregnancies. They will also ask about your family situation and social environment. If necessary, you will also be advised on support options, such as those offered by the Early help are offered. And in any case, counselling is also part of the Nutrition during pregnancy in addition.
2nd check-up (9th to 12th week)
Now the first Basic ultrasound examination is your turn. The maternity protection guidelines stipulate a total of three ultrasound examinations if the pregnancy is normal. These may only be carried out by a doctor. Your gynaecologist will now determine whether the fertilised egg has implanted as planned and whether it is even a multiple pregnancy. For most parents-to-be, it is a very moving moment to hear the heartbeat of their unborn child for the first time. This is because it can now be detected for the first time. The embryo or foetus is also measured during every ultrasound scan.
If you do not want an ultrasound scan for whatever reason, you should tell your doctor. The examination is of course voluntary.
As an additional examination, a non-invasive procedure can be performed as part of the Prenatal diagnostics between the 11th and 14th week of pregnancy Nuchal translucency measurement or a First trimester screening are carried out. Certain values are used to calculate the probability that the child has chromosomal abnormalities. However, the tests are not a standard service provided by statutory health insurance companies, although some do cover the costs voluntarily. However, if there is a justified reason for a genetic abnormality, such as in the case of certain high-risk pregnancies, the health insurance company will always pay for such tests.
3rd check-up (15th to 16th week)
The usual tests for blood pressure, weight, urine, blood and uterine status are now on the programme. There may also be a repeat antibody test for rubella.
4th check-up (19th to 22nd week)
Now it's time for the second ultrasound scan. This usually reveals the sex of the baby. However, if you do not (yet) want to know this, simply let your gynaecologist know.
You can now choose between the "classic" Basic ultrasound examination and the so-called extended basic ultrasound examination. In any case, the foetus is measured, its development is checked and it is also checked whether the spine is closed, for example. The position of the placenta in your uterus is also checked. During the extended ultrasound, your doctor will also check your baby's head with the ventricles and cerebellum. They will also look at the development of the neck and back. Your foetus's chest and torso will also be examined more closely.
5th check-up (approx. 24th to 27th week)
In addition to the usual "standard programme", the pregnant woman's blood is now tested again for any antibodies that could harm the mother and baby. Gestational diabetes screening is also scheduled between the 25th and 28th week. If unrecognised, a Gestational diabetes can be dangerous for mother and child. The glucose tolerance test, also known as the "sugar test", is used to determine your blood sugar levels. You have to drink a glucose solution for this. The values measured afterwards determine whether a follow-up test is necessary or which diagnosis is made.
6th check-up (approx. 25th to 28th week)
Your gynaecologist will carry out the usual examinations again: Your blood pressure will be measured, your weight recorded and your urine, blood and uterine position will be examined.
If your rhesus factor in the blood is negative while your child's is positive, your body may - albeit rarely - produce antibodies against the child's blood. In order to prevent such a defence reaction, there is a so-called Rhesus prophylaxis in the form of an injection with certain antibodies (anti-D immunoglobulins). Whether this is actually necessary for a mother with a negative rhesus factor can now be determined by a corresponding blood test. Since 2021, a blood test has provided information about the child's rhesus factor. This involves analysing the DNA in the mother's blood. In this way, unnecessary medication can be prevented.
7th check-up (approx. 29th to 32nd week)
Now it's time for the third ultrasound scan. Your baby will be measured again, its organs examined, the approximate Birth weight and the amount of amniotic fluid is checked. A CTG (cardiotocography) is now also carried out regularly. To do this, the pregnant woman is connected to the cardiotocograph so that the device can record baby's heartbeat and mum's contractions.
From the 32nd week of pregnancy, you will now go to your antenatal clinic every fortnight.
8th check-up (around week 34)
In addition to the usual examinations, your gynaecologist or midwife will check your baby's position. This will be felt to determine whether your baby has already turned into its birth position and is lying with its head in your pelvis. However, it may also still be lying in the Pelvic presentation - i.e. with the bum or feet instead of the head.
9th check-up (around week 36)
Now it is only four weeks until the birth. Routine examinations are still carried out and another CTG is taken. If the baby has not yet assumed its optimum birth position, special hand movements etc. can be used to encourage it to turn.
A swab may also be taken from the woman's vagina to test for a B streptococcus infection. If the mother is infected, the baby could also be infected with these bacteria at birth. This can lead to serious illnesses (e.g. blood poisoning or meningitis) in the child. To prevent this, the woman is usually given an antibiotic during labour. If the mother is suspected of having an infection, this test is paid for by the health insurance company. Otherwise it is an IGeL service.
10th check-up (approx. 38th week)
This may be your last check-up before the birth. As you already know, your blood pressure will be measured, your urine analysed, the position of your uterus felt and your baby's heart rate and the amount of amniotic fluid checked, among other things.
If your child has not arrived by Calculated date of birth If you are not yet born, you will go for a check-up every two days from this date.
