Giving birth in Bronovo Hospital

Information about giving birth in Bronovo Hospital

How the obstetrics and gynaecology (O & G) department works  

Antenatal care
Your first antenatal check-up | Further check-ups | Donation of umbilical cord blood

Antenatal testing
Blood tests | Ultrasound | Amniocentesis or chorionic villous sampling | Cardiotocogram (CTG)

Advice during pregnancy
Diet | Toxoplasmosis | Medicine | Sex | Smoking | Sport and sauna | Delivery room | Information evening
 
When to call the gynaecology outpatient clinic   

The delivery
What to bring with you | The delivery | Receiving visitors immediately after the delivery | The maternity ward | Visiting hours on the maternity ward | Baby's time table | The paediatrician

Going home 
The first few days at home | Registering the birth

And finally…
How to contact us | Recommended reading | Interesting websites | Antenatal courses

You will soon be having your baby in Bronovo Hospital
This booklet contains information about the way the O & G department works and about the care you may expect to receive during your pregnancy, labour and in the days following the delivery.

How the obstetrics and gynaecology (O & G) department works
At our hospital, several gynaecologists and registrars work together as a team. Although you will probably encounter various team members during your stay in hospital, we will try our best to for you to see the same gynaecologist and his/her assistant at your check-ups. This is the doctor with whom you can discuss your questions regarding the delivery.

If you happen to give birth during the day, you will be assisted by the registrar in charge of the delivery room on that day. There is always a gynaecologist on call. We also try our best to allocate the same nursing staff to care for you on the maternity ward.

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Antenatal care
You will have regular check-ups during your pregnancy. These check-ups will become more frequent as your pregnancy progresses. Routine antenatal check-ups are carried out:

• From week 12 to 25: every 6 to 8 weeks
• From week 26 to 31: every 3 to 4 weeks
• From week 32 to 37: every 2 to 3 weeks
• From week 38 to approx. 41 weeks: every 1 to 2 weeks
• Between 41 and 42 weeks: every 2 to 3 days
• More often if necessary

Your first antenatal check-up
The first antenatal check-up will take longer (approx. 20 minutes) than the following check-ups. This is because in addition to a physical examination, you will also be asked about your health, the health of your family and partner, and about any previous pregnancies. This information is required in order to anticipate any possible complications. 

The estimated date of delivery will be calculated from the date of your last period or from an early ultrasound scan, whichever is more accurate.

You may hear or see your baby’s heartbeat for the first time. The doctor will take your blood pressure. Your blood will be tested for blood group, Hb (haemoglobin) level Rhesus factor, anaemia, diabetes, Hepatitis B (an infectious liver disease), Lues (a sexually transmitted disease or STD), Rubella (German Measles), and irregular antibodies against red blood cells (see the leaflet “Blood tests during pregnancy”). An HIV test will also be carried out. Further blood tests to detect anaemia will be carried out during the course of your pregnancy.

Once you have had your first antenatal check-up you must register with a maternity care provider (“kraambureau”) to arrange maternity care (“kraamzorg”). To find out how to do this, please contact your health insurance provider. Early on in your pregnancy it is also important that you arrange for a post-natal check-up for when you have gone home after the delivery. You can do this by contacting either a midwife in your area or your family doctor. Addresses of midwives in your area are available from the gynaecology department, or you can find them in the Yellow Pages.

Further check-ups
Further check-ups will include assessments of your baby’s growth. The heart will be examined, as will the child’s position. Your weight and blood pressure will be measured, and urine or blood samples taken if anything is wrong with your blood pressure. The gynaecologist or registrar will inform you about your baby’s development, its position, and whether or not it is engaged at the end of the pregnancy.  You can always discuss any questions, complaints or worries you may have with the doctor. Please do not hesitate to discuss anything that is either unclear or worrying you.

Donation of umbilical cord blood
The doctor may ask for your permission to have umbilical cord blood taken from the umbilical cord which is left attached to the placenta after the cord has been clamped and cut. Umbilical cord blood is special because it contains stem cells, which are required for stem cell transplants. Stem cell transplants are carried out in order to treat children with serious blood diseases such as leukaemia. This ‘left over’ umbilical cord blood, is otherwise thrown away. If you would like to know more about donating umbilical cord blood, please ask for the leaflet entitled: “Donation of umbilical cord blood”. Take your time to think about this. It goes without saying that the decision is entirely yours.

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Antenatal testing

Several routine tests are carried out in order to monitor the progress of your pregnancy. These include taking your blood pressure and blood samples. Additional tests such as a CTG (Cardiotocogram) or an amniocentesis may be carried out if there is an increased risk of complications.
(more information: The 20 week ultrasound, RIVM - brochure .pdf)

Blood tests
Blood samples to detect anaemia will be taken several times during your pregnancy. Anaemia is a fairly common complication of pregnancy and can usually be treated successfully with iron tablets. If your blood pressure is too high, blood tests may be done to check liver and/or renal function. Sometimes it is necessary to check the blood sugar levels during pregnancy. For instance, if there is a history of diabetes in your family, or if you are overweight. Your doctor will explain this in more detail if relevant.

Ultrasound
The ultrasound examination uses high frequency sound waves in order to make the inside of the uterus (womb) visible. These sound waves are not audible to the human ear.   The ultrasound examination is painless. A gel is applied to the skin of your abdomen and a probe that sends out sound waves is then passed over the skin. The sound waves are reflected back to the probe and relayed to a computer where they are processed and turned into an image that can be viewed on a screen. 

Using ultrasound it is possible to determine the position of the placenta and measure the size of your baby throughout pregnancy. Ultrasound can sometimes reveal the presence of fetal abnormalities and can be used to calculate the amount of amniotic fluid. You will also see your baby’s heart beating. Ultrasound examinations can also detect a multiple pregnancy at an early stage. 
Ultrasound examinations are entirely safe. The sound waves are not the same as x-rays.  

Vaginal ultrasound examinations are usually carried out before the 12th week of gestation. A narrow probe is used covered by a sterile plastic cover to avoid any risk of infection. In this way your pregnancy can be visualised at a very early stage.

Amniocentesis or chorionic villous sampling
In pregnancies where there is an increased risk of chromosomal and/or some genetic diseases, an amniocentesis or chorionic villous sampling can be carried out to help to detect this. Possible diseases include spina bifida, digestive system disorders, and chromosomal abnormalities such as mongolism (Down's syndrome). 

At your first antenatal check-up your doctor will discuss with you whether you have an increased risk and whether you are eligible for one of these tests. There are national regulations in the Netherlands as to who is eligible for these examinations and when they may be carried out or not.  

Amniocentesis and chorionic villous sampling are usually carried out at the Bronovo Hospital. The gynaecology department at the Bronovo Hospital works in cooperation with the Leiden University Hospital (LUMC).

CTG (Cardiotocogram)
If your blood pressure is too high, the baby too small, you feel less movement than normal, or the pregnancy is overdue, your baby may benefit from extra monitoring. This can be done by means of a CTG. During a CTG examination the baby’s heartbeat and the activity of the uterus are registered for about 30 minutes. Information about the heartbeat and any uterus contractions is printed on a strip of paper. The doctor who has been treating you uses this information to determine the baby’s condition.

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Advice during pregnancy

Diet
It is important that you continue to eat a varied and healthy diet throughout your pregnancy. Leaflets containing further information on healthy eating are available from the gynaecology outpatient clinic. You should, however, try to remember the following tips:

• Do not eat more than usual, in particular snacks and sweets
• Do not use vitamin supplements without first consulting your doctor
• Do not eat raw animal products, such as raw or rare meat
• Wash raw fruit and vegetables. This helps to prevent toxoplasmosis (an infection that can be harmful to your child).
• Avoid blue cheeses and cheese made with unpasteurised (raw) or unsterilised milk (particularly French cheese) as these may contain Listeria bacteria, which can be harmful during pregnancy.
• Do not eat liver-based products more than once a week as these contain high levels of vitamin A (this can be harmful to your child).

Toxoplasmosis
It is important that you wear gloves when cleaning your cat’s litter tray or when working in the garden. Cat faeces, in particular from kittens, may contain a parasite that can cause toxoplasmosis.

Medicines
Never take medicines or vitamins without first discussing this with your doctor. We strongly advise against the use of even aspirins or laxatives.

Sex
You may feel tired, nauseous, or simply “different than usual” during the first 3 to 4 months of pregnancy. This may cause you to feel less like having intercourse. It is normally safe to have sex during pregnancy, unless you experience any loss of blood. As the pregnancy progresses, you may find that the contractions of the uterus following an orgasm feel uncomfortable. This is nevertheless harmless, unless you also experience loss of blood or fluid.

Smoking
There are many risks associated with smoking and pregnancy. Not only if you yourself smoke, but being exposed to smoke regularly can also be harmful. Cigarettes contain harmful substances that constrict the blood vessels and reduce blood flow to the placenta. The baby may not grow properly as a result of this.
Babies whose mothers have smoked during pregnancy therefore tend to have a lower birth weight than normal and are often born prematurely. This can make the baby more vulnerable to problems. These children are more likely to experience respiratory problems during the first year of their lives. Cot death is also more prevalent in households with smokers. Our advice to both parents is therefore to stop smoking and avoid smoky places whenever possible. Ask your family doctor or midwife for advice, and do not hesitate to ask for further information or for help to give up smoking.

Sport and sauna
Sport is healthy, also during pregnancy. It is good to keep your body in shape, although it does depend on the kind of sport you practice and how you do it. We advise you therefore to take care when practising sport. Always stop or slow down if your body tells you to, and consult your doctor if you are in any doubt about your sport.

If you are used to going to the sauna, you can continue to do so throughout your pregnancy. Do remember, however, that you may feel hot sooner as your body temperature is higher during pregnancy. If you are not used to going to the sauna, it is better to wait until after your pregnancy.

Delivery room
The Bronovo Hospital has six modern delivery rooms that are equipped with all the equipment needed to ensure a safe birth. There is always a doctor present, 24 hours a day. The gynaecologist and paediatrician can be called at any time, as can the operating theatre team.
The delivery rooms are comfortably furnished and each has its own toilet, telephone and radio/CD player. Most rooms also have a shower. You may take photographs during delivery, even during a caesarian section. If you are borrowing a camera, do not forget to try it out first. You may also use a video camera in the delivery room, although this is not allowed in the operating theatre. 
There are several ways in which you can give birth at this hospital. For example, you may give birth lying on your back, on your side or in a sitting position. The beds in the delivery room are electrically adjustable for your own personal comfort. Unfortunately it is not possible to arrange a water birth at the Bronovo Hospital. Please let us know your wishes beforehand.

Giving birth is a major event. We therefore try our best to make the atmosphere in the delivery rooms as pleasant as possible so that you feel at ease. It is possible that you will spend quite some time in the delivery room before actually giving birth. We recommend that you bring with you the things that make you feel comfortable and relaxed such as your favourite music.

We regard the room in which you give birth as your own room. We therefore consider it important that your privacy is safeguarded as much as possible. If you have any further wishes or requirements regarding the delivery, please do not hesitate to tell the nurse looking after you.

Information evening
All the deliveries that we supervise take place in the Bronovo Hospital. Regular information evenings are held to inform parents-to-be about giving birth at the Bronovo Hospital. We recommend that you reserve a place beforehand by filling in the form available in the waiting room or from the Bureau Voorlichting & Documentatie (Information and Documentation Centre) in the central hall.

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When to call the Gynaecology outpatient clinic

Before 37 weeks:

• If you lose blood or amniotic fluid
• If your abdomen becomes hard and painful at regular intervals, i.e. every 5 - 10 minutes, for longer than one hour.
• If you no longer feel any movement, or you feel less movement than normal
• If you have had an accident (bicycle, car, a serious fall etc.)
• Whenever you are worried about something

After 37 weeks and before 42 weeks:

• If you lose any bright red blood that is not slimy and fills more than one sanitary towel
• If you lose amniotic fluid
• If you have had contractions that occur every 5 minutes for over 1 hour
• Call us if you think the contractions are getting stronger and more regular. If you no longer feel any movement, or you feel less movement than normal

If you are asked to come to the outpatient clinic, please bring with you what you need for yourself and the baby just in case. Towards the end of your pregnancy your gynaecologist will tell you exactly who you should contact if you think you have gone into labour.

Call the Bronovo hospital main telephone number, 070 - 312 41 41, and ask to be put through to the labour ward. The nurse in charge will answer.  You may call for advice or fro reassurance, to arrange for an extra check-up if necessary, or because you have gone into labour. 

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The delivery

What to bring with you
As an expectant mother, the main things you will need for the birth are:

• 1 or 2 short nightgowns or T-shirts in which you would like to give birth
• a pair of warm socks
• enough pairs of knickers (not too small - do not forget you will be using large sanitary towels)
• a nightgown or pyjamas for after the birth
• toiletries such as shower gel, toothbrush, and toothpaste
• slippers
• dressing gown
• photo camera
• list of important phone numbers

For the baby:

• several vests or romper suits
• two sleep suits or sweater and pants
• two cotton hats
• a jacket or thick cardigan with hood 
• an approved baby car seat (e.g. Maxi-Cosi).

Make sure that everything you bring for the delivery fits into a week-end bag or case. You can leave the baby car seat in the car until after the birth.  

On arrival in the delivery room, you will be met by one of the nurses on duty, and the duty doctor, sometimes accompanied by a registrar. The nurse will carry out the first checks. You will also be told how to operate the bed and the nurse call bell, as there will not be a member of staff with you the whole time. 

A CTG is usually the first test to be carried out. This records uterine activity and the baby’s heart rate. It is painless and safe for both mother and child. The doctor who will assist you with the delivery will evaluate the CTG and may want examine you internally. If the birth is not expected within a short period of time, you may be sent home and told when to contact the hospital.

The delivery
Once labour has started, you will be asked every 20 to 30 minutes about the contractions. Are they coming more often? Are they getting stronger and lasting longer? Can you cope or do you need to be given any assistance/advice or pain relief? What is the baby’s heart rate? How is the baby reacting to the contractions?

The nurse will regularly offer you and your partner something to drink. The hospital kitchen provides three meals a day at set times. There are however no meals available in the evenings or at night, so please remember to bring something with you from home if necessary. You will be advised about what you can or should eat and drink according to your individual situation.

Immediately after the baby is born it will be placed on your abdomen and you or your partner will be offered the opportunity to cut the umbilical cord. After a short time, your baby will be checked by the doctor, weighed, and dressed. A dressing will also be applied to the umbilical cord. Of course the baby will be given a name band immediately after birth.

The baby remains in the delivery room. Should any immediate medical attention that be required, this will be given in an adjoining room equipped with all the necessary equipment. 

Of course we also check and look after the baby’s mother. If you wish to breastfeed, we will help you with this and give any advice you might need. It is nevertheless useful to get yourself prepared for breast or bottle feeding during the pregnancy. There is plenty of literature available on this subject.

Newborn babies are not washed immediately after the delivery as the white vernix covering the body at birth contains protective substances. Your baby will be bathed later either on the maternity ward or at home.

You will remain in the delivery room for about 2 hours after the birth. You will then be helped to have a shower or washed in bed depending on how you feel and what you want. You will then either go home or spend some time on the maternity ward. This decision is always made in consultation with the doctor.

Receiving visitors immediately after the delivery
Visitors are always welcome straight after the delivery, even at night. We do however appreciate it if you arrange this in consultation with the duty nurse.

The maternity ward
If you remain in hospital for the days following the delivery, you will stay on the Amalia ward. This ward is on the same floor as the delivery rooms. You will be admitted to a 4-person room if you have given birth as an outpatient. If you are spending all or part of the confinement period in hospital, we will try to offer you a single or twin room. All rooms are equipped with a television and a telephone. Please let the staff know if you want to use these facilities; a small fee is charged. You will be given a separate leaflet containing further general information about Bronovo Hospital when you arrive.

The gynaecologist and/or registrar will drop by every day to see how you and your child are doing. It is sometimes possible to stay in a room on the paediatric ward if your baby has been admitted there. If not, you will stay on the maternity ward. The nurses will help you with breast or bottle feeding and looking after your baby. The position of the uterus will be checked every day, as will your temperature, pulse, blood pressure and stitches, if any.
It is important to us that you enjoy this period. We therefore encourage your partner, and any other children you have, to get involved with caring for the baby.

Visiting hours on the maternity ward
You and your baby are likely to have lots of visitors. This is very understandable. You will discover however that it is better for yourself, and any roommates, not to have too many visitors at once. We therefore recommend that you arrange visits by appointment. It is also advisable to keep the visits short. Please do not hesitate to ask if you would like our support in this matter

Visiting hours
Daily from 3.30 p.m. to 4.30 p.m. and from 6.30 p.m. to 7.30 p.m.
Weekends also from 11.15 a.m. to 12.15 noon.
For fathers only: open visiting hours on the maternity ward from 8 a.m. to 10 p.m.

Baby’s timetable
For the last few years we have been using a “rooming-in” system. This means that the baby stays with the mother 24 hours a day provided this is medically acceptable. There are a few exceptions to this rule, which we will of course discuss with you when relevant.

If the baby is also staying in your room at night, you can always call the nurse for help with feeding and changing your baby’s nappies.

The paediatrician
We will inform you if your baby needs to be treated by a paediatrician. If your baby has to be admitted to the paediatric ward you will have the opportunity to visit your child very often. The paediatric ward is on the same floor as the delivery rooms and the maternity ward. There is a separate leaflet available about the paediatric ward, and ward staff will be happy to provide detailed information if required.

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Going home
The doctor and nurse will discuss with you when it is best to go home. You will be given an appointment for a post-natal check-up, and the necessary instructions for when you get home.

The safest way to transport your baby is in a baby car seat. Remember to practice installing it before you have the baby. If you do not have a baby car seat we recommend that you sit in the back of the car with your baby.

If any questions or problems arise you can always contact us for advice.  

You will be given written details to take home with you for use by your maternity nurse (“kraamverzorgster”), midwife or family doctor.

The first few days at home
At the beginning of your pregnancy you will have requested maternity care (“kraamzorg”) at home after the delivery. A maternity nurse (“kraamverzorgster”) will help you to care for your baby and will carry out the necessary checks.

The maternity nurse will continue the maternity care that began in hospital. Remember there are many good methods to breastfeed and to care for the baby. Choose the method that suits you best.

The medical checks during the first few days at home will be carried out by your midwife or your family doctor. He or she will visit you and carry out these checks 2 to 4 times on average. You will have made arrangements for this with the midwife or family doctor early on in your pregnancy. Blood will be taken from the baby at home by a heel prick (PKU/CHT/AGS) after 4 days.

Registering the birth
Your child must be registered at the Civil Registry Office (“Burgerlijke Stand”) at the town hall in the municipality where the child was born. In your case this will be The Hague. This can be done by your partner or one of the other people who were present at the delivery. Labour ward staff will provide the birth certificate, which should be taken to the town hall. The registration must take place within 3 days of birth (not including weekends), at one of the district council offices (stadsdeelkantoren).  

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And finally…  

How to contact us
You can call the gynaecology outpatient clinic on weekdays from 8.30 a.m. to 4.30 p.m., telephone number 31 (0)70 - 312 46 90.

In the event of an emergency at night or during the weekend, please call the labour ward at the Bronovo Hospital: telephone number  31 (0)70 - 312 41 41 Please ask for the labour ward.

Gynaecology consultations by appointment only!  

Gynaecologists
Dr. C.A.G. Holleboom
Ms. dr. H.T.C. Nagel
Dr. J.P.T. Rhemrev
Ms. M.J.M. Smeets
Dr. W.J. van Wijngaarden
Ms. E.H. Witte
Ms. K.E. Boers
H.M.P. Pelikan

Nursing staff Gynaecology outpatient clinic 
Ms. G de Boer-Betten
Ms. B. Dingjan
Ms. S. van den Hil
Ms. M. Middel
Ms. F. Oskam
Ms. J. van der Sterre-Nootenboom

Antenatal courses

• You can participate in various courses organised by ‘Thuiszorg Den Haag’ (Home Care in The Hague-Meavita Group). The central telephone number is 31 (0)70 - 379 51 33
• Antenatal swimming- ask for information at your local swimming pool
• Haptonomic pregnancy counseling
• Mensendieck therapy during pregnanacy
• Access: prenatal and post-natal courses by Acces, Plein 24, The Hague. Tel. 070 - 346 25 25. www.access-nl.org

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