Pregnant women will all be offered Down's Syndrome screening

Women now have around 14 checks - but new guidelines say this should be cut to 10 for first pregnancies and seven for subsequent ones.

The National Institute for Clinical Excellence said all pregnant women should be offered Down's Syndrome screening.

But it said routine tests for diabetes in pregnancy should end.

Pregnancy check timetable Before 12 weeks - one or two appointments plus option of screening tests 16 weeks - test results Abdomen, blood and urine checks at 25, 28, 31 and 34 weeks 36 weeks - check baby's position Abdomen, blood and urine checks at 38 and 40 weeks

The experts who drafted the national standards for the NHS in England and Wales said the guidance was not aimed at cutting costs.

It is the first major change to the basic pattern of antenatal care since the 1920s.

They say reducing checks for healthy women would mean more attention could be given to women with pregnancy problems.

Hospitals will have to implement the recommendations - a failure to do so could affect their star ratings, and therefore their funding.

Click here or scroll to the bottom of the page to submit your comments.

The guidance says that, although there should be fewer appointments, they should start earlier in pregnancy.

Screening plan

Most women currently only see a doctor when they are around 12 weeks pregnant.

Experts say seeing a doctor or midwife earlier - at around eight weeks - would give women more time to make decisions about screening and to plan what kind of care they want during their pregnancy.

The NICE guidance recommends all women should be given an ultrasound scan at 10 to 13 weeks to estimate when the baby is due, instead of estimates being based on the date of a woman's last period.

It will act as a checklist for clinicians and women Dr Maggie Blott, Royal College of Obstetricians and Gynaecologists

NICE recommends that all women should be offered a test for Down's, whatever their age.

The Department of Health has said all women should be offered the test by April next year.

But the NICE guidance says women and their partners must receive comprehensive information and advice about any test they have.

Women found to be at a high risk would then be offered invasive tests to see if their baby did have Down's Syndrome.

The Down's Syndrome Association said it welcomed extended testing, but said women must be given full information about the condition itself as well as the tests they are being offered.

But critics said the message was being given out that some lives were "unworthy".

Patrick Cusworth, spokesman for the pro-life charity Life, said: "It is an insult to all born people with Down's syndrome.

"So-called 'experts' believe they can make judgements about an individual's 'quality of life' when plainly they cannot."

However, NICE said hospitals should stop carrying out routine blood tests for gestational diabetes.

Research call

The guidance was put together by a team including midwives, obstetricians and patient group representatives from the National Collaborating Centre for Women's and Children's Health (NCCWCH).

The NICE guidance will tie in with a National Service Framework on children's care which the government is set to publish next year.

Dr Peter Brocklehurst, director of the National Perinatal Epidemiology Unit who led the development of the guidelines, said any problems that developed would be spotted in time with the new schedule of checks.

"I can reassure women that for problems like pre-eclampsia, the frequency of visits will be enough to detect problems before harm comes to them or their babies."

Dr Maggie Blott, of the Royal College of Obstetricians and Gynaecologists, added: "This guideline will help standardise the care of pregnant women across the country.

"It will act as a checklist for clinicians and women and inform women what to expect at appointments."

Mary Newburn, Head of Policy Research, National Childbirth Trust, welcomed standardised care and information for women.

"Women find it extremely baffling that something is seen as necessary and important in one place and doesn't come into the picture somewhere else."

She said conventional appointments were not meeting women's needs, and other kinds of support such as community drop-in centres should be considered.

"We must be much more imaginative about how we do meet the needs of women and their partners during pregnancy."

But Liz Kendall, director of the Maternity Alliance, warned: "A reduction in the average number of antenatal visits for most mothers must be accompanied by concerted efforts to improve the availability and quality of care for disadvantaged pregnant women."

A Department of Health spokeswoman said: "This guidance will form the backbone of the maternity module of the Children's National Service Framework, which will set national standards of care for antenatal, delivery and postnatal services."

Sandra Gidley, Liberal Democrat women's spokesperson warned: "The gap in checks between 16 and 25 weeks may leave some women ill at ease about how their pregnancy is developing.

"If this interval is to become part of the framework for pregnancy care, women must be aware of the danger signs, and have the confidence to seek medical attention straight away."

Should pregnant women get more or fewer check-ups? What have been your experiences of pregnancy care in the UK? Send us your thoughts.

I think that as long as the pregnancy is proceeding normally then the new recommendations would be adequate. However, I hope that there will be exceptions written in to the proposal to cover genetic screening and mothers with a history of miscarriage, for example. I have heard that women in the rest of Europe are offered up to 6 ultrasound scan - I would like to know why this is and should more scans be available to mothers in the UK. I welcome the opportunity for all women to have a 12-week scan as my experience has been the offer of a solitary 20-week scan and a fee of �95 for the 12-week scan. I think that all mothers would benefit from the reassurance of a heartbeat and the ability to acknowledge the development of their unborn child. I read that the proposed reduction in appointments is not to save money, however I am sure that this will be a welcome side effect of the scheme
Dr Tanya Nicholls, UK

The NICE and government should be ashamed of themselves Mrs Burns, England

I am currently 24-weeks pregnant. I feel that antenatal checks are vital during pregnancy. Being at risk of pre-eclampsia, I feel that reducing the number of antenatal appointments is dangerous. My mother had a heart attack at 29 weeks pregnancy whilst carrying me and I feel safe knowing that I see the midwife on a fortnightly basis. This proposal is a nonsense. The NICE and government should be ashamed of themselves.
Mrs Burns, England

I think as long as a woman is healthy and having a good pregnancy she shouldn't need so much intervention as she gets at the moment. My own pregnancy was completely healthy yet I felt I was handed from pillar to post - doctor, midwife, obstetrician, scans - each one telling me everything was OK when I knew perfectly well that it was. I had to take loads of time off work and I'm sure that their time could have been better spent on women who were having problematic pregnancies.
Kerry Lecomber, UK

I have got 2 children - one 7 and one 4. But last year I had an early miscarriage at 9 weeks and in July I had a late miscarriage at 18 weeks due to a faulty placenta. Luckily I was monitored both times before the miscarriages occurred and luckily we found the second one died a few hours previously or else I would have waited until my 20 week scan when the baby would have turned and caused possible infection. The reason I was watched is because a high level of AFP was found in my blood when I had the triple blood test, the consultant said it sometimes was linked to pre-eclampsia and low birth weight later on. He wanted to start regular scans to check baby's growth. It was at this scan we found out my baby boy had died, I was devastated but if I would of had to wait until my 20 weeks scan it would have been much worse. I have been since contemplating another pregnancy but since reading this report I must say I doubt whether I will go ahead. It just proves to me that the NHS is going down hill, I am slowly losing faith in it.
Karen Taylor, England

I'm pregnant, not ill Yve, UK

I'm 36 weeks pregnant and booked in at Sunderland, which already runs the reduced checks model - 7 checks for healthy, low-risk second time or later mothers, and 9 checks for first time mothers like myself. I have been perfectly happy with this arrangement - I'm pregnant, not ill. Admittedly, I've not been in the best of health all the way through the pregnancy, but that's been more of a reflection of my general state of health pre-pregnancy. I've always been confident that if I have any real concerns, I can make an appointment with a GP, or phone my midwife team. I also had a scare very early in the pregnancy and was taken very good care of, being very promptly, upon the first appearance of problems, given a series of early scans to check that everything was OK.
Yve, UK

Why don't people have some tests BEFORE pregnancy occurs? A few genetic and fertility tests could not only save the country a lot of money but also would-be parents a lot of heartache.
Anne Brothwell, UK

"The NICE guidance recommends all women should be given an ultrasound scan at 10 to 13 weeks to estimate when the baby is due, instead of estimates being based on the date of a woman's last period."
What a joke, my wife and I have just had our first baby and had to pay a significant amount for this ultra sound privately as it's not done on the local NHS in our area (Berks) whereas for others around the country it is. I later found out that a lot of people go outside the area first to get it free and then re-register at their local hospital. Why do we pay the same NI as everyone else whilst the treatment we receive locally is different?
Pete, UK

I am currently 35 weeks pregnant with my first child and have felt that the number of appointments are just right. It has been quite reassuring to have my midwife confirm that things seem to be ok and also have the chance to listen to my baby's heart beat each time. If the amount of appointments are cut down I think that there should be some kind of other service put in place where first time mothers can discuss their concerns with someone who can reassure them.
Amy, Peterborough, England

Having had quite a lot of experience in my own pregnancies I can not emphasize enough how each and every pregnancy is different, and often completely unpredictable minor complications can arise, which if not picked up can lead to more complex situations arising. This has to be blatantly obvious that this is purely a money saving scheme by the government! Surely is it not in the interests of the government to ensure that children of the next generation are healthy, not to mention the maternal health too!
Mrs Roth, England

Less ante-natal appointments could mean problems not being picked up, potentially leading to major problems for mother and baby, I have had three pregnancies all quite different, so there is no reason to suppose a problem free first pregnancy will mean problem free subsequent pregnancies.
Maxine Morgan, England

Disclaimer: The BBC may edit your comments and cannot guarantee that all e-mails will be published.