Early pregnancy signs and contacting a midwife

What are the early signs of pregnancy?

The NHS says the earliest and most reliable sign of pregnancy is a missed period, for someone with a regular monthly cycle. NHS inform notes that an irregular cycle can make a missed period harder to notice. Sometimes a person who is pregnant has a shorter or lighter period than normal. The NHS lists other signs, including feeling or being sick, unusual tiredness and breasts that become larger and tender. A strange taste in the mouth, which many women describe as metallic, is also on the list. Tiredness can be marked, especially during the first 12 weeks or so. Sickness is often called morning sickness, but it can happen at any time of the day or night. Symptoms like these usually start when a person is around 4 to 6 weeks pregnant. They overlap with premenstrual changes and other conditions, so a pregnancy test is the way to find out.

How soon can a test confirm it?

The NHS says most home pregnancy tests can be used from the first day of a missed period. Tests carried out earlier than this are not always accurate. Someone who does not know when the next period is due can test at least 21 days after unprotected sex. NHS inform advises checking the expiry date on the packaging and says an out-of-date test should not be used. Some sources recommend using the first urine of the morning, because it is more concentrated. Fertility medicines based on the hormone hCG may cause a false positive result, according to a hospital guide and MedlinePlus. After a negative result, NHS inform suggests waiting two to three days and testing again. The NHS says a GP can be contacted if a second test is negative but the period has not arrived.

Who should someone contact after a positive test?

In England, the NHS website lets people refer themselves for pregnancy care online, by entering a postcode, town or city to find local trusts with maternity services. A person can choose which trust to refer themselves to. Some trusts ask people to call their community midwifery team instead, and others point to a GP referral, so practice varies. The first midwife appointment is called the booking appointment, and the NHS says it should happen by about 10 weeks of pregnancy where possible. For anyone already past 10 weeks, the NHS says to refer themselves as soon as possible to start pregnancy care. NHS inform says the midwife gives information about screening tests in pregnancy at this appointment, and blood tests are offered to those who would like them. Someone with a long-term condition or who takes medicine still needs to see a GP or specialist about any changes to their care.

What happens when someone refers themselves?

Many NHS trusts let people refer themselves for pregnancy care without seeing a GP first. NHS England has described this route as a way to get a first midwife appointment faster. Some trusts use an online form, and others use a phone number, so the process differs from area to area. One trust says its form gives the team time to arrange a first appointment for between 8 and 10 weeks of pregnancy. Checking the local trust's website is the way to find the route used in a particular area.

Which symptoms need urgent help?

The NHS separates problems that need an ambulance from those that need advice the same day. It says to call 999 or go to A&E for heavy bleeding that soaks a pad soon after it is put on. Severe tummy pain, shoulder pain, or feeling faint or dizzy in pregnancy are also signs of needing immediate treatment. The NHS gives the example of pain so severe that it stops a person doing everyday things such as watching television or reading. Sudden, intense tummy pain with feeling very dizzy, fainting or looking very pale can mean an ectopic pregnancy has ruptured, which the NHS treats as very serious. For a possible pregnancy with a combination of a missed period, tummy pain low down on one side, vaginal bleeding or brown watery discharge, or discomfort when peeing or pooing, the NHS says to contact a GP or call NHS 111. This applies even without a positive pregnancy test.

What about bleeding, miscarriage and early pregnancy units?

The NHS says symptoms of an ectopic pregnancy usually start around weeks 4 to 12, and that an ectopic pregnancy does not always cause symptoms. Vaginal bleeding is the main sign of miscarriage, but bleeding can also have other causes, so the NHS advises getting it checked. For light bleeding or spotting, the NHS says to contact a GP or maternity team, or call NHS 111. For bleeding with mild or no pain, the NHS says to call the maternity unit if there is a number. An early pregnancy unit may help if a person is under 20 weeks pregnant, and its contact details are on the local trust website or in the maternity notes. The Miscarriage Association says some units accept self-referral and others need a GP referral, so local rules vary. The NHS says a person who is unsure can call NHS 111 or the maternity unit.