Your maternity notes decoded
Juliet Blank
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Making sense of your maternity notes can feel like trying to decipher a mystical language. So what does all the jargon actually mean? We've asked midwife Leah Hazard to help interpret them and explain to us mums-to-be what they're really saying about you and your baby.
Antenatal notes are notoriously tricky to understand. But, given that they're aimed at midwives and medical professionals, it's not all that surprising.
But if you're intrigued or confused with what all those enigmatic squiggles mean about your pregnancy, let us help shed a little more light.
Together with midwife Leah Hazard, we'll help you get your head round some of the strange letters, abbreviations and phrases that will appear over the next nine months. After all, this is you and your baby's information, and it will serve you well to understand it.
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You'll usually be in charge of looking after your maternity notes, so be sure not to lose them. Your notes will also usually have telephone numbers for you to use if you need to speak to anyone, a space to write the date and time of your next appointment and a record of what you told the midwife in the booking appointment.
You may be familiar with your BP (blood pressure) for instance, but be slightly alarmed by the letters FH (fetal heartbeat) and other tests, but panic not, explains Leah:
'Your midwife will perform a detailed assessment of your health and your baby’s wellbeing at every appointment.
‘You may be familiar with some parts of these assessment, like having your blood pressure checked and your urine dipped. But other parts, like abdominal palpation (feeling your ‘bump’ carefully for fetal size, position and presentation) or auscultation (listening in to your baby’s heartbeat) may be new to you.
'Always ask your midwife to explain anything that’s unclear,' she adds.
In the meantime, here's a quick guide to your maternity notes ...
About you
Gravida, or G
This refers to the number of times you've been pregnant. If you're pregnant for the first time, your notes might say primigravida; if you've had a previous pregnancy, they'll say multigravida.
If you're pregnant for the first time and are over 35, you could see yourself referred to as an 'elderly primigravida' (the cheek!).
Parity, or P
This is how many times you've given birth. Nulliparous means you've never given birth. Primipara or primip means you've given birth once.
Multipara or multip means you've had two or more babies. Grand multipara means you've given birth three or more times.
Your ‘parity’ (the number of times you’ve given birth) can also be expressed as a sum that includes any losses you’ve had; for example, para 2+1 indicates a woman who has given birth to two babies over 24 weeks’ gestation, and has had one loss of under 24 weeks’ gestation.
A ‘loss’ could be a miscarriage or termination; your midwife will ask sensitively about any of these at your first appointment.
Gestation
This is how many weeks pregnant you are.
Your gestation is expressed in a sum of weeks and days, and is initially measured from the first date of your last menstrual period (LMP) – for example, if it’s been six weeks and four days since your last period began, then your gestation will be written as 6+4.
Your EDD (estimated date of delivery, or estimated due date) will also be calculated initially going by your last period, but may be modified slightly once you’ve had your dating scan and your baby’s size is measured more accurately.
If you’ve gone past your EDD (over 40 weeks pregnant), your gestation may be written in relation to ‘term’ (full gestation) – for example, if you’re five days over your due date, your midwife may write that you’re ‘Term plus 5’ or ‘T+5’.
BMI
This is your body mass index – a calculation that indicates the ratio of your height to weight. Both measurements will be taken at your booking appointment.
Although BMI is not a perfectly accurate indicator of a woman’s health, it can be helpful to healthcare providers in giving a rough indication of whether you’re maintaining a healthy weight.
If you’re concerned about your weight, talk to your midwife or doctor about ways of managing this in pregnancy and ensuring the best outcome for you and your baby.
Your health checks
BP
Blood pressure. This will be taken at every antenatal appointment and is recorded as two numbers, a ‘systolic’ over a ‘diastolic’ measurement, such as 120/75. If your blood pressure readings are consistently high (above roughly 140/90), your midwife may refer you for further assessment.
FBC
Full blood count. This measures a number of blood components including haemoglobin (an indicator of your iron levels), white blood cells (which can be elevated in the presence of infection) and platelets (which influence your blood’s ability to clot). You can expect an FBC at least 2-3 times in your pregnancy.
MSU
Mid-stream urine or simply Urine. Your midwife will request a urine sample from you at each appointment.
She'll dip it with a piece of special litmus paper that can detect various substances including ketones (a sign of possible dehydration), glucose (often high in the presence of diabetes), red and white blood cells (sometimes present with infection) and protein (sometimes just a result of contamination with vaginal discharge, and sometimes an indicator of possible pre-eclampsia if accompanied by high blood pressure).
The amount of each substance in your urine will be expressed with a + sign (for example, glucose + protein ++) or, if the sample is clear, the midwife may write NAD (no abnormality detected).
Oed
Short for oedema, or swelling: often a normal symptom of late-term pregnancy, but sometimes also a symptom of pre-eclampsia if accompanied by high blood pressure and protein in the urine.
Your midwife assesses this based on how you look and the symptoms you describe, and again records it as +, ++ or +++.
Your baby's heart rate and movements
FH, FHH or FHHR
This stands for either fetal heart, fetal heartbeat heard, or fetal heartbeat heard and regular, and will be accompanied by the beats per minute (bpm) – normally an average of 105 to 160bpm; so, for example, FH 146bpm.
The midwife may listen to your baby’s heartbeat with a handheld Doppler monitor (sometimes called a Sonicaid), or she may check it with a Pinard (small wooden or metal ear-trumpet that can be pressed against your abdomen).
If your baby’s heartbeat is high, this may just be a normal acceleration due to fetal movement; your midwife may wish to listen for longer than a minute to see if this settles.
If there are any sustained concerns about the fetal heart rate, you may be referred to the local assessment unit for further review.
FMF
Your midwife will ask if you're feeling your baby move, and if you are, will record it as FMF (fetal movements felt). If she can actually feel the baby move when she palpates (feels) your abdomen, she may write, ‘FMF on palpation’.
Your baby's size
CRL
This stands for crown-rump length and is the measurement from the top of your baby's head to the base of their spine. It's taken at the dating scan and is a reliable way to calculate your due date.
AC
Abdominal circumference. As your pregnancy progresses, this measurement around your baby’s belly is a more accurate indicator of their growth, and may be plotted on a special growth chart in your hospital case notes and/or your handheld notes.
FH
Fundal height - the distance from the top of your uterus to your ‘symphysis pubis’ (the bony prominence at the front of your pelvis).
Your midwife will usually measure fundal height with a simple tape measure from around 28 weeks’ gestation, and will record her findings in centimetres.
This is a rough guide of fetal growth, and if your midwife has any concerns, she will refer you for an ultrasound scan. Babies who are measuring smaller than expected on scan may be referred to as SFD (small for dates) or LFD (large for dates).
Your baby's position
Ceph: short for cephalic, which means your baby is lying head down in the uterus.
Br: short for breech, or bottom/feet down.
Long: not your baby's length, but short for longitudinal, which means your baby is in a vertical position.
Tr: this is short for transverse, where your baby lies horizontally across your bump.
Obl: oblique, or lying diagonally in the womb.
OA: occiput anterior, which means your baby is head down and facing your back.
OP: short for occiput posterior, where your baby is head down but ‘back to back’ (with its spine laying against your spine)
R or L: in front of OA and OP, this refers to which side of your body your baby is lying on. For example, ROA means right occipito-anterior; your baby is head down, facing slightly towards your right, with its back towards the front of your abdomen.
Your baby's position in your pelvis
E or Eng: this is short for engaged, which means that part of your baby's head has dropped below the brim of your pelvis.
If this is your first baby, it’s possible that your baby’s head will be at least partly engaged days or even weeks before you give birth.
However, if this is your second or subsequent baby, it’s more likely that your baby’s head won’t engage until the onset of labour.
1/5, 2/5, 3/5, 4/5 and 5/5: this is a measurement of how much of your baby's head - in fifths - your midwife can feel above your pelvis when she palpates (feels) your abdomen.
For example, 3/5 means the midwife can feel most of your baby’s head above your pelvic brim, with 2/5 of its head engaged into your pelvis.
Free: this means your baby's head is ‘free’ above the brim of your pelvis, or not engaged.
Your maternity notes will also include:
- The date of your first antenatal visit and the date your baby is expected
- any problems or care you've needed during your pregnancy
- details of your ultrasound scans and other appointments
- details of any reasons you had to go to an NHS antenatal ward or day assessment unit at your local hospital
- details of your plan for your baby's birth, including pain relief, and whether you plan to give birth at hospital, home or birth centre
- details of monitoring your baby's heartbeat
- when and how your medical team may intervene to assist your labour
- how you plan to feed your baby
- how long you plan to stay on the postnatal ward after giving birth
What to Expect When You're Expecting by Heidi Murkoff is a must-read book for all expectant parents. See more details here at Amazon.
You can also buy it here at Waterstones.
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