Frequently Asked Questions
Pregnancy
Especially during a first pregnancy — but also in subsequent ones — it can sometimes be difficult to know when you should or shouldn’t call the midwife. What is a normal part of pregnancy? What should or shouldn’t you be worried about?
If you’re feeling concerned, you can always contact us. We will provide you with guidance and determine whether any action is needed at that moment.
A miscarriage is the loss of a non-viable fetus in the first twelve to fourteen weeks of your pregnancy. About one in ten pregnancies ends in a miscarriage. Don’t look too much for reasons why you have a miscarriage, usually it is pure bad luck or coincidence.
When you are newly pregnant, it can be very worrying if you experience blood loss. However, it is very common. Light blood loss can be a cause for concern, but that is certainly not always the case. If you are concerned, you can always contact us.
As soon as you know you are pregnant, you can register with us using the registration form on our website or by telephone. The first time you come, you will receive a lot of explanation, in which we will let you know what is important to arrange. That is not a lot at the beginning. The GP, the pharmacy and the health insurer do want to know that you are pregnant. Are you not married? Then arrange, together with your partner, the recognition of the unborn child and the baby’s surname before the 24th week of your pregnancy. Also register for maternity care in time, preferably when you are about 14 weeks pregnant. You can also register for Mothers for Mothers. In this way, you help other women to fulfil their desire to have children.
During the check-up, we will check whether you and your baby are doing well. To do this, we will measure your blood pressure, feel your belly to see if your uterus and the baby are growing well, and listen to the baby’s heartbeat together with you. We will discuss your questions and any health complaints with you and ask you whether the baby is moving well. You will also receive advice about what is important at that time of your pregnancy. If necessary, we will schedule an additional examination, for example if you are overweight or if there are doubts about the growth or position of your child.
The schedule for regular check-ups is:
– During the first 24 weeks of your pregnancy: every four weeks
– From 24 to 32 weeks: every three weeks
– After 32 weeks: every two weeks
– After 36 weeks: every week
After the intake, you will be sent a maternity care plan, which is an overview of the check-ups and shows you what is done during the various check-ups
20 week scan (SEOThe schedule for standard ultrasound scans:
– 8 weeks (vitality scan)
– 11 weeks (term scan)
– 20 weeks scan (SEO)
– 32 weeks (growth scan)
If you are concerned, you can of course just call the practice and see what you need and what is possible.
– Your general information, such as your name, address, date of birth, insurance and profession.
– Medical information, such as medication use, operations you have had, allergies and any conditions such as cardiovascular disease, diabetes or epilepsy. The health of your partner will also be discussed.
– The midwife will ask whether you smoke, use alcohol or drugs, whether you have ever had a bladder infection or cold sore and whether you use (or have used) folic acid.
– Your midwife will ask questions about conditions that occur in your family or that of your partner, such as high blood pressure, diabetes, hip dysplasia and/or other congenital conditions.
– Have you been pregnant before? The midwife will then discuss the previous pregnancy and delivery with you and discuss any special details.
Childbirth
TENS
TENS (Transcutaneous Electrical Nerve Stimulation) is a device that you use to give yourself small electric shocks. This distracts your attention from the pain of the contractions. You operate the device yourself – which can give you a sense of control. The electric shocks enter your body via electrodes (wires that are attached to your back). This gives a prickly or tingling sensation, comparable to cold hands that start to tingle when they become warm again.
Advantages of TENS
• Some women experience less pain.
• It seems to work especially at the beginning of labor.
• TENS has no side effects or consequences for you or your baby.
Disadvantages of TENS
• You cannot take the device in the bath or shower with it.
• You have to hold the device all the time. Practical matters You have to rent the device yourself. Check with your insurer whether it is reimbursed.
Spinal tap (‘epidural’)
A spinal tap is an injection in your lower back with a combination of anaesthetic drugs. The anaesthetist inserts a needle into your lower back under local anaesthesia. You must arch your back and remain as still as possible while lying or sitting. A thin, flexible tube is inserted into your back through the needle. The needle is removed and the tube remains in place. You will be given painkillers through this tube throughout the entire delivery. You will feel the anaesthetic after 15 minutes.
The advantages of an epidural
• Most women feel little pain during contractions.
• An epidural works better than an injection with pethidine or a pump with remifentanil.
• An epidural does not make you drowsy or sleepy and you therefore experience the delivery consciously.
The disadvantages of an epidural
• Occasionally an epidural does not work or does not work sufficiently. It is not known exactly how often this occurs (probably between 5 and 10%). The epidural injection is sometimes given again.
• Some women experience itching during an epidural injection. This is related to the composition of the medication.
• You cannot get out of bed because you have less feeling in your legs. This slowly returns when the administration of medication is stopped. With a low dose, you have more feeling in your legs and you can sometimes stand and walk.
• Occasionally, women suffer from headaches after an epidural injection. This can be remedied with medication.
Remifentanil pump
Remifentanil is a morphine-like substance that is administered via a tube in the arm (infusion), which is attached to a pump. You can determine the amount of remifentanil that you receive via the infusion yourself using a push button. The pump is set so that you can never give yourself too much.
Advantages of remifentanil
• Remifentanil works quickly, often after just a few minutes.
• Remifentanil numbs the pain about as well as pethidine.
• After delivery, remifentanil disappears from your blood fairly quickly.
Disadvantages of remifentanil
• Remifentanil can affect your breathing and the amount of oxygen in your blood. That is why you and your baby must be carefully monitored continuously when using this drug.
• Remifentanil numbs the pain less well than an epidural.
• You can no longer walk around. The drowsiness can cause you to fall.
• The effect of remifentanil on breastfeeding has not yet been properly investigated.
See the leaflet ‘How to deal with pain’.
– Always call during the day. (8-20 o clock)
– Do not call at night if the baby’s head has descended properly, you are between 37 and 42 weeks pregnant, you are not having contractions and the amniotic fluid is clear. You should call in the morning.
– If the baby’s head has not descended properly during the check, lie down and call the midwives day or night.
– If the amniotic fluid is green or brown in colour, always call the midwive.
It is normal to lose the mucus plug from 37 weeks. You do not need to call if you lose light pink or brown mucus.
– First child: If you have contractions every 2-3 minutes for 1 hour, lasting 60-90 sec.
– Second/third child: If you have contractions every 5 minutes for 1 hour, lasting 60-90 sec. If you think the delivery is going very fast, you can always call earlier.
We are available 24 hours a day, 7 days a week for advice and support.
But call us in any case if:
– Worrying
– Bright red vaginal bleeding
– Feeling less life (from 28 weeks, see brochure)
– Loss of amniotic fluid before 37 weeks.
During pregnancy, this is of course discussed extensively. You often have a lot of information from sisters or friends. Everyone has a unique story. The course of a delivery can never be completely predicted, but many things can be influenced by good guidance and preparation.
In a birth plan, you and your partner can record your specific wishes regarding your delivery. We have a document that can help you with this. You will receive it from us during pregnancy. The intention is that everyone involved in your delivery reads it and takes it into account. In a birth plan, you record your wishes and ideas. For example, about pain relief during delivery. About who you want to be present at your delivery and who not. Whether, and when, you want photos to be taken and by whom.
Here we have to distinguish between a patient with or without a medical indication. With a delivery with a medical indication, giving birth in hospital is absolutely safer. Often both mother and baby need to be monitored more intensively than we can do in a home situation. With an patient without medical indication delivery, it is not medically necessary to give birth in hospital, this is your own voluntary choice. The delivery is in fact the same as a home delivery but at a different location. With both deliveries, the midwife has the same instruments at her disposal to monitor you and the baby and to guide your delivery. In short, giving birth at home or in hospital is equally safe.
Giving birth at home is possible when there is a healthy pregnant woman and a healthy pregnancy. This means that the check-ups with the midwife have gone well, normal blood pressure, a healthy growing baby, nice heart sounds, etc. There should also be no medical impediments in your history or family. If you are unsure whether you should give birth at home, always discuss this with your midwife. Furthermore, the pregnancy must be at or beyond 37 weeks and before 42 weeks.
Postpartum period
Pelvic floor complaints
Your pelvic floor muscles are stretched during childbirth. After childbirth, these muscles slowly regain their old shape and strength. You may suffer from pelvic floor complaints. How do you recognize these and what can you do about them?
Complaints
You may suffer from the following complaints
• loss of urine, especially when coughing, sneezing and lifting (stress urinary incontinence)
• inability to hold wind
• loss of stool
• a heavy feeling of pressure in the lower abdomen and pelvic floor
• pain in the pelvic floor area, for example when cycling or pain during sex
Reducing complaints
About 6 weeks after childbirth, the complaints should decrease – with exercises. If this does not happen, contact your GP or a pelvic therapist. Pelvic floor muscle exercises
When you are rested after giving birth, you can immediately start with a number of exercises to strengthen your pelvic floor muscles
Blood loss
The first 24 hours after giving birth, you will usually experience a lot of blood loss. You may also lose clots. Sometimes these are the size of a fist. As long as you feel well, this is not harmful. You are losing too much blood if you have a full sanitary towel every fifteen minutes. In that case, contact your midwife. It is normal to have to change sanitary towels approximately every 3 hours. The days after giving birth, the blood loss is usually (much) more than during a normal period. After a few days, the blood loss decreases. It can last for about 4 to 6 weeks. The blood loss is then no longer bright red, but somewhat browner. At the end of the maternity period, the discharge will be more white or yellow.
Stitches
Your midwife will tell you whether you have stitches and, if so, how many. Stitches should not hurt in principle. Do you have a painful pelvic floor?
Tips:
• Take a warm shower in the morning and afternoon
• Sit on the stitches. Preferably on a hard surface
• Cool the stitches with cold compresses
• Take paracetamol
The first few days after giving birth, urinating is often sensitive. This is because urine is acidic and may corrode the wound. To remedy this, you can rinse with water while urinating, for example using a jug. Urinating while showering can also help. Do not postpone urinating. The maternity nurse checks the wound every day and calls the midwife if something is not healing properly. Most stitches dissolve on their own. Around the 7th day after giving birth, the remaining or painful stitches are removed.
Cold sores
A newborn baby is very susceptible to infections. The herpes virus, which causes cold sores, can make your baby sick. If you have a cold sore yourself, it is important to pay close attention to your hygiene. If necessary, wear a face mask and wash your hands thoroughly to prevent contamination. If visitors come with a cold sore, do not let them kiss or cuddle your baby. Certainly until he or she is 1 year old.
Postpartum blues
More than half of women who have just given birth suffer from postpartum blues, or: baby blues. You recognize postpartum blues by sudden mood swings and/or unexpected crying fits. This is because fatigue sets in, your hormones are ‘out of whack’, you may suffer from engorgement and you suddenly have a baby to take care of. On the 3rd to 5th day after giving birth, you can suddenly become very emotional. It all becomes too much for you and you suddenly have to cry. The baby blues usually disappear after a few days. It is better to take it easy on these days and not have too many maternity visitors.
Afterpains
You often have little to no afterpains after a first delivery. You may suffer from them after a second or third delivery. Paracetamol can help (maximum 6x 500mg per 24 hours). Breastfeeding increases the feeling of afterpains. Afterpains are there for a reason. They ensure that the uterus shrinks quickly and that you bleed less. The afterpains will diminish and disappear after a few days. A hot water bottle against your lower abdomen can sometimes provide relief.
Psychological problems
In the first period after giving birth, 1 in 10 women suffer from mild to very serious psychological complaints. How do you recognise these and what can be done about them?
Postnatal depression
You can recognise postnatal depression by feeling sad, not feeling like doing anything, not wanting to eat and not being able to sleep. If you have gloomy moods that do not go away, you lie awake all night, you cannot enjoy things (not even your newborn baby; perhaps you do not want to hold him or wish he had never been born), you have no appetite and are dreading the day, talk about it with your midwife or maternity nurse. In 1 in 10 women, these depressive feelings do not go away by themselves after giving birth. They end up in a postpartum depression, or a postnatal depression. This depression can last for weeks, months or sometimes longer.
Symptoms
Postnatal depression can vary in severity — from mild to very serious. Crying, anxiety, irritability, overthinking, and poor sleep are its most common symptoms. Sometimes, extra support is needed to help build a strong bond between you and your baby. In most cases, postnatal depression can be treated with therapy, medication, or a combination of both. So if you recognize these symptoms, please talk to your midwife or maternity nurse.
Muscle soreness
Childbirth is often compared to running a marathon — and with good reason. After a (normal) delivery, it’s completely normal to experience muscle soreness and stiffness throughout your body.
Tip: Take it easy and allow yourself to be taken care of, so your body can recover gently.
Bowel movements
During the first few days, you often won’t have a bowel movement yet. It may feel difficult when it does return, but in most cases, it’s not as bad as you expect.
Tips:
• Stay well hydrated
• Eat fiber-rich foods
• Take your time with meals and drinks
Adjusting to a new life
Some women feel like they’re on cloud nine after the birth of their baby and enjoy every moment. Still, most women find that recovering from childbirth and adjusting to life with a newborn can be quite challenging.
Rest
Giving birth is physically demanding. Your body needs time and rest to heal. Of course, it’s great if you start feeling well again soon after delivery — but take it easy. Once the maternity nurse leaves, you and your partner will be on your own, and you’ll still be getting up at night to feed the baby. Try to rest when your baby sleeps. When you’re overtired, it’s much harder to cope, and you may feel like you’re losing control.
Getting to know your baby
The early days are a time to get to know each other. The arrival of your baby brings a big change to your life, and it takes time to adjust. Your baby needs love, security, and a sense of safety. When your baby cries, it’s okay — and even beneficial — to pick them up and comfort them. This builds trust. The more you connect with your baby, the better you’ll come to understand their needs.
Insecurity
Feeling uncertain about being a parent is very common. You may wonder: Can I really do this? Is this how I imagined it would be?
Take comfort in knowing that confidence usually grows over time — you’ll get the hang of it.
Postpartum recovery (hormonal adjustment)
After childbirth, your body begins the process of returning to its pre-pregnancy state. Significant hormonal changes take place: your hormone levels temporarily drop, often even lower than before pregnancy. Your body produces less progesterone and estrogen, and immediately starts producing hormones to support milk production and to help your uterus contract. This transitional phase is called postpartum recovery.
During postpartum recovery, you may experience symptoms such as:
• Fatigue
• Irritability
• Difficulty concentrating
• Feeling down or low
• Back pain
• Headaches
• Hair loss
• Irregular or absent menstruation
• Feeling generally unwell
Postpartum recovery typically takes about nine months.
What if the symptoms don’t go away?
Some women continue to struggle with symptoms like sadness, fatigue, or irritability. Not everyone feels like they’re on cloud nine — in fact, most women don’t, or only briefly.
Don’t keep it to yourself. Talk to your midwife or GP if you’re feeling this way.
Sweating
Some women experience excessive sweating, especially at night — sometimes so much that you need to change your shirt. This is completely normal and usually resolves on its own.
You are required to register the birth of your baby within 3 days. This must be done in the municipality where your child was born. After registration, the registrar of births, deaths and marriages will issue a birth certificate.
If birth registration is not possible due to a weekend or public holiday, the deadline is extended to ensure at least two working days remain to complete the registration.
Between the 4th and 7th day after your baby is born, the heel prick test will be performed. As the name suggests, this involves taking a small blood sample from your baby’s heel. It is important that the heel is warm. Most babies don’t mind the prick itself, but rather the squeezing of the heel — warming the heel beforehand usually helps prevent discomfort.
The blood is tested for a range of conditions. These are mostly rare metabolic disorders that can be harmful to the baby but are treatable with medication or a special diet. The test also screens for adrenal and thyroid function, two hereditary forms of anemia (and carrier status), and cystic fibrosis.
The heel prick is done at an early stage so treatment can start in time if needed. If you don’t hear from your GP or from us within 3 weeks, the results are normal. In rare cases, something may go wrong during testing and the heel prick needs to be repeated — but this is uncommon.
Around the 36th week of pregnancy, you will receive a leaflet from us with more information about the heel prick test.
The hearing test is preferably performed within 2 weeks after birth, usually around day 5 of the postpartum period. Ideally, the test is done while the baby is asleep. A small earpiece is placed in the baby’s ear that emits a high-pitched sound. The test measures the echo that bounces back from the eardrum.
The results are given immediately. If there is too much background noise, the test may need to be repeated. The hearing test is usually arranged by the maternity nurse.
If you are under the care of a gynecologist during pregnancy due to a medical indication and give birth in the hospital, there is often no reason to remain in the hospital after delivery. The gynecologist will transfer care to a midwife.
We recommend registering with us during your pregnancy for this postnatal care. After the birth and your discharge from the hospital, we will visit you at home following our regular schedule of postpartum check-ups.
We will visit you several times during the postpartum period. Together with the maternity nurse, we’ll check how you and your baby are doing. The maternity nurse keeps a record and will consult us if she notices anything unusual.
For the mother, we monitor breast engorgement, uterine contraction, and the healing of any stitches. We also keep an eye on temperature, pulse, urine output, and bowel movements. In addition, we pay attention to your emotional well-being and check whether you’re experiencing more uncertainty than usual.
For the baby, we observe skin color, urination and bowel movements, feeding behavior, and growth.
The eighth day is, in principle, the last day of your postpartum period. We will transfer your baby’s file to the Youth and Family Center. From this point on, care for your baby will be continued by the child health clinic.
It is important to arrange maternity care early in your pregnancy. After the birth, the maternity nurse will come to your home and monitor the health of both mother and baby. She will help you care for your baby, support you with breastfeeding, and temporarily take over some household tasks. She also keeps a record for us.
Maternity care is spread out over several days, with the nurse present for a few hours each day. We cannot do our work properly without good maternity care.
In principle, the postpartum period lasts 8 days. If medically necessary, it may be extended to 10 days. The number of hours of maternity care you receive depends on your health insurance and medical situation.
The Importance of Maternity Care
It is important to arrange maternity care early in your pregnancy. After the birth, the maternity nurse will come to your home to monitor the health of both mother and baby. She will assist you with caring for your baby, support you with breastfeeding, and temporarily take over some household tasks. She also keeps a record for us.
Maternity care is spread out over several days, with the nurse present for a few hours each day. We cannot do our job properly without good maternity care.
