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Objective: To determine the uptake of current antenatal HIV testing, the prevalence of risk factors for HIV in pregnant women and the acceptability of the rapid point-of-care HIV test (RPOCT) among pregnant women and their midwives. Design: A retrospective review of 717 notes to determine current HIV screening practices and a cross-sectional survey using a self-completed questionnaire for pregnant women and midwives. Setting: The antenatal clinic (ANC) and postnatal wards (PNW) at a university teaching hospital in the West Midlands. Participants: 486 women attending the ANC or admitted to the PNW during a fortnight in May–June 2006. 72 midwives on the delivery ward completed a second questionnaire. Results: The questionnaire showed that 90.4 % of those offered the standard HIV test accepted it, with 7.2% having at least one risk factor for HIV. Over half of the decliners perceived themselves as not at risk. 85.2% would accept the rapid test, including 35.6 % of the decliners. 92.8 % of midwives agreed/strongly agreed the RPOCT has a role on the delivery ward and 97.2 % would be happy to offer the test with appropriate training and guidance. Conclusions: Midwives deem the RPOCT to be appropriate for a variety of perinatal settings. It is als