Pregnant

Registration

You can register as soon as you know you are pregnant. You don't need the intervention of your GP. We make the first appointment for an intake interview when you are about seven weeks pregnant. We advise every woman who is pregnant or who wants to get pregnant to take 400 to 500 micrograms of folic acid each day.

You can register by means of the registration button on this site. On working days, we can also be reached by telephone during the obstetrician's surgery hours, between 9 and 13 am.

First check-up

The first visit, the intake interview, takes place when you are around 8 weeks pregnant and takes about 45 minutes. It is an extensive interview with wide-ranging questions about your health, your partner's health, any surgery you underwent, illnesses and allergies.
We will also discuss if there are any congenital disorders or hereditary illnesses in your family and your partner´s. If so, we will see if there is an indication for a more extensive examination of the baby's health. Apart from your health, the progress of any previous pregnancies is important information to us as well.
In order to calculate how long you have been pregnant, it is necessary to know the progress of your periods. Important dates include the first day of your last period and the day on which you took the pregnancy test.
The first scan is preferably conducted 8 weeks into your pregnancy and is usually done internally, through your vagina. The second scan is conducted 10 to 11 weeks into your pregnancy and is done externally, through your abdominal wall.

Scan and Examination:

Blood test:

During your first visit, we will hand you the forms you will need in order to go and take a blood test. We will examine the following:

• What is your blood group: A, B, AB or O?
• Are you Rhesus D-negative or Rhesus C-negative?
• Does your blood contain antibodies against blood groups other than your own?
• Are you infected with syphilis (lues), hepatitis B or HIV?

If the blood test shows your unborn child is at risk of getting ill, it is often possible to treat you during pregnancy and thereby protect your unborn child. That is why we conduct the blood test in the early stages of your pregnancy, so that any treatment can be started soon if necessary. The laboratory also establishes the iron and sugar levels in your blood. If your iron levels are too low, you suffer from anaemia. This can usually be treated successfully, without any harmful effects to your unborn child.
If necessary, more blood tests will be conducted after mutual consultation. For instance, in order to exclude the risk of pregnancy diabetes.
The organisation that will take your blood samples is called Starlet. For the nearest centre, visit www.starlet-dc.nl.

Prenatal examinations:

Combined test

The combined test, which is conducted in the early stages of pregnancy, serves to find out if there is an increased risk of your unborn child having Down's syndrome. The chances of your child having Down's syndrome increase as you get older. This test poses no risks you on your unborn child.

Links to leaflet about prenatal screening for Down's syndrome

http://www.rivm.nl/dsresource?objectid=rivmp:51018&type=org&disposition=inline&ns_nc=1

Structural Ultrasound Scan

http://www.rivm.nl/dsresource?objectid=rivmp:56912&type=org&disposition=inline&ns_nc=1

Childbirth

To prepare for childbirth, we recommend reading the following leaflets: "How to prepare" and "How to deal with pain during childbirth".

http://www.knov.nl/uploads/knov.nl/knov_downloads/485/file/Voorbereiding-Engels_webversie.pdf

http://www.knov.nl/uploads/knov.nl/knov_downloads/499/file/Pijn-Engels_printversie.pdf

Notification instructions
If you are less than 37 weeks pregnant and you feel you are about to give birth, you must call us immediately on the emergency number. This may be the case when you experience regular abdominal pains, when you lose liquid or blood. We will come and visit you to examine you and refer you to the gynaecologist if necessary.

After 37 weeks of pregnancy, it is perfectly normal to give birth. In that case, you call us;

Contractions

• First child: when, for a period of 2 hours, you have been suffering from regular painful contractions every 3 to 4 minutes that last 60 seconds.
• Second or subsequent child: when, for a one-hour period, you have been suffering from regular contractions every 4 to 5 minutes.

Your waters break

• Normal amniotic fluid (your waters) is either clear/colourless, greyish or pinkish - with or without flakes.
• Always try and collect some in a glass.
• If your amniotic fluid is green or brown, you have to call us immediately.
• If your waters break during the night, and they are normal appearance, you call us the next morning around 8.45 am.
• If your waters break during the day, and they are normal appearance, you call us immediately (until 10 pm).
  
  Blood loss
  Losing some mucus, sometimes accompanied a little blood, is quite normal towards the end of your pregnancy. The so-called sputum may contain a little blood. You don't have to call us when you lose the sputum, but you always can, should you have any doubts.
  If you lose blood you must call us on the emergency number immediately, at all times. Losing blood during contractions is normal, but if you need to change your sanitary towels several times every hour, you are losing too much blood. If you are unsure and/or if you think you are losing too much blood or you lose blood without having contractions, contact us immediately at all times.
  
  You can always call us when in doubt or when you are worried.

What happens when you call us?
When you call us, we will visit you at home. We will check how you deal with the contractions. Sometimes they fade when we visit. That's quite normal, it often means you are in the early stages of childbirth. We also feel your belly and listen to your unborn child's heart. If necessary, we will conduct an internal examination in order to see how much you are dilated. For a first child, this is often 1 to 2 centimetres during the first visit. Depending on the stage of childbirth, we will make an appointment for our next visit or your next call to us. If you want to give birth at the outpatients' clinic, you may come to the hospital yourself, where we will meet for the next check-up. So we may visit you at home a number of times before we stay with you or before you go to the hospital to give birth at the outpatients' clinic. When you give birth at home, we will call a maternity nurse towards the end of dilation. We can also call the maternity nurse earlier on during childbirth, so she can support you during the contractions, if you want.

Postnatal check-ups

The first week after childbirth is referred to as the confinement period. This is a special period during which you will get to know your baby. Your body will be going through a lot of changes and it can be an emotional time. It is a week full of questions and, at times, uncertainties. We will visit you on a regular basis during this period, usually every other day. We will look back at the birth, we look at how you're doing and we will answer your questions.
During this period, you can of course always call us on the emergency number, 24 hours a day.

Registration

Once it is born, your child must be registered with the local authorities. You have to do this in the town or city where your child was born. This must be done within 3 working days and you have to make an appointment at the town hall. If your child is born on a Thursday, Friday, Saturday or national holiday, you have 2 working days. You can make an appointment on the Internet; www.alkmaar.nl or by calling 14 072. The father, mother or any person who witnessed the birth can register the child.

Maternity care

The maternity nurse helps out with home births, and during the confinement period she will check mother and child. For eight days, she will help you care for your child, she will explain breast feeding or formula feeding and offer practical advice. She writes down everything in a so-called "care file" and will contact us if there are any particulars. A maternity nurse is vital if you want good care during home births and the confinement period. If you need more help than the standard 8 days, we may extend maternity care to 10 days.

In our region, we mainly use the services of de Kraamvogel  www.dekraamvogel.nl .

Heel prick and hearing test

In the first week after your child is born, a screener from the GGD (Municipal Health Service) will visit you to conduct a heel prick and hearing test. The hearing test serves to find out if your child hears sufficiently well for it to learn how to talk. Your child will not be affected by this test in any way. During the heel prick, a little blood is taken from the baby's heel. The blood is tested for 18 rare hereditary disorders. The heel prick must be conducted within a week. As soon as your child is registered with the local authorities, they notify the GGD. They will usually call you before they visit you.

For more information you can visit:

http://www.rivm.nl/dsresource?objectid=rivmp:75162&type=org&disposition=inline&ns_nc=1

Miscarriage:

A miscarriage may manifest itself in different ways:

1) You lose clear red blood and suffer from abdominal pains. When the blood loss continues, gets worse and is accompanied by severe contraction-like abdominal pains, you may be about to miscarry or are in the middle of a miscarriage. Your body is expelling the foetus. If you've given birth before, you will probably recognise your abdominal pains as contraction pains.

2) Sometimes nothing appears to be wrong. You're not losing any blood and you feel pregnant, just like before. During a scan, no heart beat is detected for the foetus. It is highly likely that the foetus died earlier, but has not been expelled yet.

3) Sometimes the scan only shows the amniotic sac, not the foetus. This means something went wrong in the very early stages of pregnancy, before the embryo was formed.
 

What to do when it is confirmed you miscarried?

When you've been given the devastating news that something went wrong with the pregnancy, it is important to take your time to reflect and think about your options. If you know you will be miscarrying, you have three options.

1. Wait/Spontaneous miscarriage

As long as it is medically responsible, you can wait for 2 weeks to see if you spontaneously miscarry. This is a very precarious period, after all, you don't know how and when the process will start.
A miscarriage usually occurs spontaneously and without complications, so there is no need for medical intervention. After the initial blood loss, the miscarriage will start within a few days, but sometimes it may take a little longer. It should take no more than a couple of weeks. The blood loss continues for a number of days and then changes to heavy blood loss and cramps. The moment your womb starts expelling the foetus, you will have contractions in order to slightly open the cervix. This can be quite painful. When the foetus is expelled, you may suffer from heavy blood loss.

If you're not prepared for this, it can be quite a shock. The blood loss may be so serious that sanitary towels will not help at all. The blood literally pours out. Soon after that, the cramps reach a climax and you feel 'something' popping out of your womb. That's the foetus. After the foetus has been expelled, the pain will subside and the blood loss will return to the levels of a normal period. You will continue to lose blood for a couple of days and after a few weeks, your normal periods will resume. Sometimes, the bleeding won't stop and the miscarriage turns out to have been incomplete. In that case you will be referred to a gynaecologist for curettage (cleaning of the womb).

If you decide to wait and see, we will give you an explanation and instructions about when to call us. Sometimes nothing happens in the agreed period, in which case we will discuss your follow-up options. After a miscarriage we will conduct a scan to make sure the miscarriage has been complete.

Call the obstetrician on duty in the event of:

• Severe blood loss that continues for more than 4 hours
• Dizziness or seeing stars
• An increase in pain or constant pain
• Fever. A body temperature of 38 degrees Celsius or higher
• Worry

2. Medication

A second option is to take medication that will expel the pregnancy tissue from the womb. When a miscarriage does not start automatically or if you don't want to wait, it can be induced by means of medication (Misoprostol). These are tablets that must be inserted via the vagina. They will cause the womb to contract and the cervix to open (see spontaneous miscarriage). We will refer you to a gynaecologist for an examination. Together you will set the date on which to take the medication. You will then be given the tablets, which you can take in the comfort of your own home. You then await the miscarriage, which usually takes place within two days. Misoprostol is effective in 80% of cases. When it is not, you will undergo curettage.

3. Curettage

If you opt for curettage, we will refer you to a gynaecologist for an examination. In the case of curettage, the gynaecologist removes the pregnancy tissue from your womb by means of a thin tube (vacuum curettage) or a curette. This takes about five to ten minutes and is done in the outpatients' clinic. You will be given either a light anaesthetic or an epidural. You can also have curettage under full anaesthetic.
The reason why a physician will never use this as a first option is clear: it is a relatively simple procedure and an anaesthetic always poses a risk, no matter how small.

Don't think lightly of curettage. If you have a scan and you are told something is wrong with your pregnancy (missed miscarriage), your instinctive reaction will often be to immediately opt for curettage. That is in fact a logical reaction. However, experience has shown that later on, you feel it all went right past you. After all, all you did was go for a first scan, full of hope and expectations, and suddenly your world has been turned upside down. You need time to absorb it all.

All three options come with pros and cons. Your decision is a matter of personal preference. Take a few days to decide and talk to us if you feel the need. Taking your time will help you deal with the situation and it makes you aware of the fact that you have to (for now at least) say goodbye to the new life you and your partner have been dreaming about.