Midwifery practice

Information brochure midwifery practice Bronovo hospital

Table of contents

Introduction
Prenatal care | First check-up | Blood-test | Ultrasound scan | Follow-up checks | Changes in the body | Feeding recommendations | Bacteria and harmful substances | General advice | Hospital delivery | Postnatal visits | Breastfeeding | Things you need for you and your baby | Pregnancy courses | Complaints procedure | Contact / telephone numbers |

Introduction
Thank you for registering at the midwifery practice of the Bronovo hospital. This brochure will inform you of the way we provide midwifery care (consisting of prenatal, natal and postnatal care). We would also like to present an overview of the physical changes which occur during pregnancy, the most common complaints will be discussed and we will provide a number of practical recommendations.

In our practice a group of midwives work as a team. You will meet them during the prenatal check-ups. Your delivery will not be scheduled with one special midwife, but will be accompanied by the midwife on call at that time.
Sometimes you may meet a student-midwife in our practice. We think it is important for future colleagues to acquire practical experience. If you have any objection to the presence of a student midwife, do not hesitate to inform us.

Prenetal care
During your pregnancy you are checked frequently. In the beginning of the pregnancy, your check-up will be scheduled every 6 weeks. In the second trimester, it will be every 5, 4, 3 and 2 weeks and, in the last stage of your pregnancy every week. Of course, you can call us if you have any physical complaints. You can fi nd the phone numbers and phone consulting hours on your appointment card (and at the end of this brochure). If you need to cancel your appointment, please do so in good time (not later than 24 hours before the appointment). Otherwise, we regret that you will be charged for charged the no-show tariff.

First check-up
Once you are registered, the first check-up takes place as soon as possible so that you can ask the midwife any questions regarding your pregnancy in time. This first check-up will take about half an hour and you will be asked a lot of questions by the midwife.
We will be asking you about your medical and obstetrical history as well as hereditary diseases in both families.
The first check-up will take place before the 12th week of the pregnancy. At this early stage, it is not yet possible to hear the heartbeat of the baby.

Blood test

After the first check-up your blood will be tested for

• your blood type
• Rhesus factor
• irregular antibodies
• Hepatitis B (liver disease)
• syphilis and HIV (Sexually Transmitted Diseases)
• Rubella (German measles)
• haemoglobin level (anaemia)
• glucose level (diabetes)

Around 24 weeks of gestation, you will be checked for diabetes again and around 30 weeks your haemoglobine-level (iron) will be re-checked. If your blood type is rhesus negative, we will test your blood for the presence of rhesus antibodies in the 30th week of pregnancy. If there are no antibodies present, we will give you an injection with anti-D-rhesusimmunoglobulin antibodies.

Ultrasound scan
As soon as possible an ultrasound scan will be made to determine the exact due date. You should make an appointment after your fi rst telephone contact with an assistant.

An ultrasound scan is a diagnostic technique which uses high-frequency sound waves to create an image of the uterus and the baby. The sound waves are not audible to the human ear. The ultrasound is not painful and the procedure is as follows: fi rstly the skin of the abdomen will be covered with gel. Then the abdomen is explored with a probe that transmits sound waves. The sound waves are refl ected, received and stored and processed by the computer. That way an image appears on the monitor. In a very early pregnancy, the scan may be performed internally – i.e. via the vagina.
With an ultrasound scan - for example – scan measurements of the baby can be taken and the location of the placenta can be determined. By means of ultrasound we can determine at an early stage if there is a possibility of a multiple birth. There is a separate Bronovo brochure concerning ultrasound research for pregnant women. You can ask our assistant for it, or you can pick it up at the Information and Documentation Desk (Bureau Voorlichting & Documentatie) in the Central Hall.

You will be given the results of the ultrasound scan immediately. Please bring these papers with you to the following check-up that will be about in the 15th – 16 week of your pregnancy. You can already make an appointment for the 20th week ultrasound scan.

At 18 - 22 weeks, the so-called routine echo-screening takes place. This is a medical echo. It is done to detect signifi cant structural malformations such as spina bifi da, hydrocephalus or serious heart defects. However, not all congenital abnormalities can be detected with these echo scans. Further echo scans will only be preformed if there is a medical necessity for them.

Follow-up checks
The following antenatal visits will take approximately 10 minutes. During these check-ups, your blood pressure will be measured, you will be weighed, the growth and position of your baby will be monitored and you will hear the baby’s heartbeat. Naturally there is enough time for questions.

Changes in the body
Pregnancy is not an illness. Generally you can continue doing everything you did when you were not pregnant such as sports, sexual relations, working and driving. It is important that you take good care of yourself, listen to your body and follow these guidelines:

• Nausea
  Morning sickness is one of the fi rst signs of pregnancy. It is caused by a pregnancy related hormone. Some women suffer from morning sickness, others are sick on and off during the day. Generally morning sickness disappears around the 16th week of the pregnancy. If you suffer from morning sickness, we recommend that you eat a cracker or a biscuit and drink something immediately after you wake up in the morning (or even better; have breakfast served to you in bed!). To prevent nausea during the day, it is better to avoid having an empty stomach. Eat small amounts regularly, crackers for example. Make sure you always have something to eat with you.
  
  Clear soup is recommended when you feel weak. Ginger (tea or chewing on a ginger root) can be helpful. If these tips do not help you enough, your family doctor can prescribe a medication against nausea. If you vomit a lot (several times a day) you also should contact your family doctor.
  
  
• Weight increase
  On average, a woman gains 10 to 15 kilos during pregnancy. The baby takes what it needs from the mother or her reserves. As a result, the weight increase differs per woman and some women even lose weight. We check your weight every visit because most women want to know their weight (gain) even though there is no medical need for this. If you would prefer not to be weighed at every check-up, you can indicate this.
  
  During the pregnancy your sugar and fat metabolisms slow down. This may mean that you gain a lot of weight even though you eat normally. We advise you to drink a lot of water (approximately 1.5 - 2 litres a day), so as to try to limit your weight increase. If you gain more than 20 kilos, you have to carry around a lot of extra weight. This causes unnecessary strain on the back, pelvis and knees.
  
  
• Ligament pain
  During the fi rst trimester of the pregnancy the uterus grows very fast. The uterus is attached to the surrounding tissue by ligaments. The uterus muscles stretch more easily than the ligaments. Sudden movements such as turning and standing up can cause sharp pains that have no infl uence on the pregnancy or the baby. Try to move slowly and ease any pain with a hot-water bottle.
  
  
• Constipation and diarrhoea
  The bowel movements are also infl uenced by hormones. The walls of the intestines slacken causing the bowel movements to decrease. This can cause constipation. Moreover the bowels are pushed upwards and sidewards by the growing uterus, causing them to be compressed. As a result some women have constipation and others diarrhoea. This can lead to very painful cramps and sharp pains in the abdominal region. This does not infl uence your baby or the pregnancy. When your bowels are very disturbed, the uterus may react by getting hard or sensitive.
  When you suffer from diarrhoea for several successive days, we recommend that you use oral rehydration salts (ORS). These are a mixture of sugars and salts and help to prevent dehydration.
  ORS is available from the chemist or ‘apotheek’. Please contact your family doctor if you have diarrhea for more than two days. If you are constipated, we advise you to drink a lot of water (2 litres a day) and to eat food with plenty fibre.
  Constipation may cause haemorrhoids. Haemorrhoids are blood vessels that are pressed outwards and form lumps around the anus. Hard stools can rupture a blood vessel, causing some visible blood loss in the stool or when you wipe yourself clean. This blood loss is not dangerous. The haemorrhoids can be very painful for you but they are not dangerous for the baby. The midwife can prescribe a special ointment.
  
  
• Movements of the baby
  Often you feel the fi rst movements of the baby at 20-24 weeks gestation. This depends (among other things) on the location of the placenta in the uterus.
  Until the 28th week of gestation, you do not have to feel the baby moving every day. After that time, you do have to feel the baby moving every day. When the movements of your baby suddenly change, please contact us. There will always be days when you are busy and it seems that the baby moves less. Often the baby lies in a different position at that moment, for example with the legs towards your back, which could be a reason why you feel less movement. Take a warm shower or bath, rub your abdomen with oil and try to convince the baby to move by pressing your stomach softly. If the baby doesn’t respond with its normal movements within 2 hours, we advise you to contact us.
  
  
• Irregular heartbeat and shortness of breath
  The blood circulation of the uterus and the placenta is the number one priority for the pregnant body. The placenta is a very complicated organ comprising a mass of blood vessels that guide suffi cient blood to the placenta. The total blood volume, therefore, increases to 1.5 litres. The heart has to pump all this extra blood through the body and this can cause irregular or fast heartbeat, a completely normal phenomenon in pregnancy.
  In the first trimester you may experience a shortness of breath caused by the hormonal changes. In the second half of the pregnancy, the diaphragm will move upwards to make room for the growing uterus and this pushes the intestines up. This leaves less space for the lungs and may cause fast and shallow breathing, leading to shortness of breath. This sensation is normal. Some women suffer from hyperventilation. In that case too much oxygen is inhaled which may cause symptoms like tingling hands, a heavy feeling on your chest or fainting, that may lead to a panic attack. This is not dangerous for you or your baby. There is an easy way to stop hyperventilating; cup your hands, cover your nose and mouth and breathe in and out. If you have a plastic or paper bag, you can breathe in and out in that. This way you limit the oxygen intake. You keep breathing like this until your breathing is normal again and the tingling hands and dizziness disappear.
  
  
• Blood loss
  Pregnancy can unfortunately, sometimes be accompanied with blood loss. Blood loss causes concern and is a reason to contact the midwifery practice, so advice can be given, either over the phone or in a check-up at the practice. In most cases, the blood loss is caused by the extra fl ow of blood in the uterus and vagina. Blood loss can be caused by making love or passing stools. This blood loss is no problem and is usually restricted to a few drops of fresh red blood or brown blood.
  
  
• Cystitis
  Cystitis is common in pregnancy because the bladder is suppressed by the growing uterus. After urinating, urine may remain in the bladder and provide bacteria with a chance to grow. The usual causes of bladder infections are not so clearly evident during pregnancy. If the stomach is distended, urination frequent and some blood in the urine, there may be a bladder infection. If you suspect cystitis, ask your family doctor to test your morning urine. If necessary your family doctor will prescribe antibiotics. You have to use all the prescribed antibiotics and ask your family doctor to recheck your urine one week later, to make sure the cystitis is gone. Cystitis in pregnancy does not disappear spontaneously and has to be treated with antibiotics. To prevent cystitis we advise you to drink a lot of water, at least 2 litres a day.
  
  
• Lower back and pelvic pain
  The growing uterus requires your body to find a new balance. It is like carrying around a crate of soft drinks with you all day long. When you do this with a hollow back, the back is strained too much. Do not walk around with a hollow back but tilt the pelvis to keep the back as straight as possible. You will put less strain on your back this way. Do not stand still for too long and make sure that if you do, your feet are a little apart. Sometimes a hot-water bottle can help to ease the pain. When your daily activities are seriously limited, you can ask us to refer you to a physiotherapist to help you with you posture.
  Because of hormonal changes, the cartilage between the pubic joints softens and your pelvis can become more mobile. This mobility is necessary for the delivery. During the pregnancy, this increased mobility can cause pain. Physiotherapy can help with this as well. It is important to know that you can not damage your pelvis with normal movements. We advise you to continue moving normally but at a gentler pace. Swimming can help and it also makes the muscles in the pelvic area stronger.
  
  
• Heartburn
  As soon as you become pregnant, hormones are released that are not normally present. They infl uence a lot of processes and are very important for the pregnancy. Unfortunately some hormones have annoying sideeffects. Heartburn (which is a regurgitation of acidic stomach fl uids) is one of these side-effects. The body increases the production of gastric acid and the sphincter between the stomach and the oesophagus relaxes. Moreover, large quantities of fast foods or rich meals produce extra gastric acid. It is better to have frequent smaller meals during the day, than to have 3 large meals. Do not drink your drinks too cold or too hot and do not eat spicy foods if you are not accustomed to them. In the fi rst months of the pregnancy, it may help to eat some custard or to chew hazelnuts fi ne and to swallow them. If this does not help, you can ask your family doctor for a prescription. You can buy different kinds of chewing tablets and drinks at the pharmacist without a prescription. Make sure to elevate your head when you go to sleep. When you lie fl at on your back, you get even more heartburn.
  
  
• Oedema
  Oedema is a normal sign of pregnancy and is caused, among other things, by the hormonal changes. Moreover, the growing uterus impairs the circulation and the backfl w of blood and fluid from the tissue. The Oedema can cause your hands, feet, legs and labia to swell. It is important to continue drinking 2 litres of water a day and to massage the swollen body parts to improve circulation. By elevating the foot end of your mattress a little, the fluids can fl ow back more easily during the night. It is not necessary to reduce your salt intake.
  
  
• Distended stomach
  The uterus is a large muscle and, just like any other muscle, it can contract and relax. When the uterus contracts, this feels like a hard stomach. This is a normal reaction of this muscle. At the end of the pregnancy, the uterus practises for the delivery and often it will feel like a hard ball inside you. This is a normal phenomenon unless the hard stomach occurs irregularly and is painful. Certain movements, stress, heightened strain and intercourse may cause hard stomachs. This can occur early on in the pregnancy. When you experience a lot of contractions, we advise you to take more rest. You can have your family doctor check some (morning) urine to make sure that these contractions are not caused by cystitis. Warm showers, baths or hot water bottles reduce the pain of hard stomachs. If you have doubts you can contact the midwife.
  
  
• What to do and what not to do during pregnancy
  We have already mentioned that pregnancy is a natural process. But that does not mean that you pay it no attention. You can give nature a helping hand by doing certain things and by not doing others.

Feeding recommendations

• Fresh vegetables, lettuce and fruit are important suppliers of vitamins, minerals and fi bres. It is important to wash fresh fruits and lettuce and pre-packed vegetables thoroughly.
• Potatoes, wholemeal bread, rice and pasta are important energy sources.
• Milk, cheese, eggs, meat, chicken and fish are important for the calcium and protein needs of mother and baby.
• (medium-fat) Margarine and butter provide Vitamins A and D.
• Extra vitamin D is recommended during pregnancy.
• Drink a lot of water, a minimum 1.5-2 litres a day.
• Eat fibre rich food such as whole meal bread, beans, grains, lettuce and whole grain rice.
• Be careful with sugar and moderate your sweets intake.
• Reduce the intake of so called ‘light’ products because of the possible harmful side-effects of sugar replacements.
• Drink small amounts of coffee. When you drink more than 4 cups of coffee a day, the baby can get restless as a result of the caffeine. You can choose to drink caffeine-free coffee.
• Do not drink milk or other dairy products at mealtimes. These products contain calcium and calcium obstructs iron absorption. It is better to drink water or fruit juice with your meal. Fresh juice contains Vitamin C and this facilitates the absorption of iron. Commercial fruit juices unfortunately also contain (added) sugars. It is better to prepare your own juice from fresh fruit.
• Eat fresh oily fish during the last trimester of the pregnancy. Fish contains certain fats that benefit the brain development of the baby.
• A healthy and varied diet contains all the required vitamins and minerals. It is therefore not necessary to take (pregnancy) vitamins, except vitamin D.
• In case you question your diet you can use prenatal vitamins after consulting the midwife. For more information: www. voedingscentrum.nl. This site gives much information for pregnant mothers.
• Limit the amount of liver or liver products. Liver contains a lot of Vitamin A. Too much Vitamin A can be dangerous for the unborn baby. You should, therefore, eat no liver during the pregnancy and only choose once a day a liver product such as liver sausage, liver paste, paté, Hausmacher or Berlin sausage.
• Do not diet. During pregnancy it is very important to eat healthily and have a varied diet. “Eating for 2” is not necessary, but losing a lot of weight during the pregnancy (or breastfeeding period) is not recommended. In the fat tissue of the body, among others, harmful substances are stored. When you diet, these substances end up in te blood circulation, and this can be dangerous for the baby.

Bacteria and harmful substances
Smoking
Smoking during pregnancy carries risks. Both first and passive smoking can be bad for the pregnancy and the baby. Cigarettes contain harmful substances that limit the blood flow through the placenta and decrease oxygen supply for the baby.
This may result in foetal growth retardation. Children from smoking mothers are often born with a low birth weight and are often born prematurely. They can therefore be more vulnerable. During their fi rst years, they suffer more frequently from lung diseases and cot death occurs more often in families of smokers. The advice for both parents is: quit smoking and avoid smoky areas. You can ask your family doctor or midwife for advice and support.
See www.babyfit.nl/adviesopmaat.nl (in Dutch).

Drugs
Hard drugs are very bad for your unborn baby. Use of hard drugs (amphetamines, XTC, heroin and cocaine) during pregnancy is harmful. Hard drugs can cause serious congenital malformations. The baby also becomes addicted and has to detox after birth in the post-natal ward. Babies are often born prematurely and there is a higher risk for the baby to die just before or after birth. The decreased oxygen supply can cause growth retardation. The use of softdrugs is also not allowed because mostly they are combined with tobacco. Side-effects of these substances on the development of the baby are still little known. If you are using drugs or have used drugs recently, you have to tell the midwife.

Alcohol
Alcohol use during pregnancy can damage the baby because its immature liver is unable to break down alcohol. Children of mothers who drink too much alcohol whilst pregnant are more likely to develop congenital abnormalities of the central nervous system, the heart, kidneys and of the face. There is an increased risk of retarded foetal growth. As children grow older various disorders can occur including hyperactivity, lower intelligence and later mental development. To sum up: it is wiser not to drink any alcohol from the conception until the end of breast feeding.

Toxoplasmosis
When you are cleaning the cat litter or you are working in the garden, it is important to wear gloves. Cat litter may contain parasites that can cause toxoplasmosis. Raw meat can also contain these parasites. The parasites may cause an infection. Contamination during the pregnancy may cause congenital malformations. Because of this you should not eat raw of half-cooked meat such as roast beef, tartar, fi let Américan or ossenworst (sausage) but make sure your meat is well cooked. Meat products like salami are not dangerous because they have had a special treatment.

Listeria
Soft cheeses made of raw milk (Brie, Camembert and Roquefort) may contain the listeria-bacteria. Healthy adults will rarely get sick from these bacteria but unborn babies are sensitive to them. When a cheese is made from raw, unpasteurised milk the package states “au lait cru”. Listeria can also grow in raw products like vegetables, chicken, meat and fi sh when these are kept in the refrigerator for a long period of time. Keep these products as little as possible and better still; eat them fresh. Listeria can easily be destroyed by boiling of frying your food. Already cooked meals can be kept in the refrigerator (for some time). Raw milk from a farm has to be boiled before you drink or use it. Fresh vegetables (also pre-packed vegetables and lettuce) have to be washed thoroughly before use.

Medication
Only use medication prescribed by your doctor or midwife. Inform your midwife at the prenatal check-up about any medication (also homeopathic) that you use.

Chemicals
Avoid coming into contact with the following substances whilst pregnant; turpentine-based paint, pest killing substances, chemicals (for example used for fi lm developing) and laser games. So far there are no harmful side-effects known from using hair dye. But to stay on the safe side, we recommend that you avoid types of hair dye that contain lead solvents and check with your hairdresser what type of hair dye would be most suitable.

Radiation
If X-rays are necessary during pregnancy, mention clearly that you are pregnant. Sometimes the test(s) can be postponed until after the delivery. Often the uterus can be protected from X-rays.

General advice
Sauna and solarium
It is unknown if high surrounding temperatures during pregnancy are harmful. However, it is probably advisable to avoid long hot baths, the sunbed and sauna (especially infra-red saunas), particularly in the first trimester.
The sunbed may also cause or worsen a pregnancy mask (brown discoloration of the facial skin). This can also happen after intensive sunbathing.

Sport
Sport is healthy, also during pregnancy. It is good to keep your body in shape, but adjust your pace. Swimming, cycling and fi tness (with exception of crunches) are sports that you can keep doing until the end of the pregnancy. We advise you not to play sports like hockey and tennis, because the ball could hit you in your stomach, or sports, where you can easily crash into other people (skiing) or fall (horse riding). We do not recommend intensive aerobics or sports on a professional level.

To sum up; keep doing what you are used to doing. Listen to your body, so you will stop in time to avoid complaints. Do not exert yourself more than before your pregnancy. Make sure you drink enough during and after sports.

Sexuality
The perception of sexuality during pregnancy can be different for every woman. Some women are more and some are less in the mood for sex. Complaints like tiredness and nausea can get in the way. Painfully swollen breasts can become more painful with sexual excitement. Often there is more need for touch and intimacy than for intercourse. These are normal changes in sexuality during pregnancy. In a ‘normal/healthy’ pregnancy, you can continue having intercourse like you used to. This does not cause a miscarriage nor does it damage the baby. Only if the membranes have ruptured or if there is blood loss, do we advise you to restrain from intercourse.

Problems with sexuality can always be discussed with the midwives. This includes negative sexual experiences. The midwife will ask you about this during the fi rst check-up. If you expect any diffi culties with an internal examination, please inform us so that we can keep this in mind during the delivery.

Work
Working has no harmful side-effects for the pregnancy. But certain working conditions can be diffi cult whilst pregnant. Therefore there are special rules for pregnant and breastfeeding employees. These rules can be found in “Arbeidsomstandighedenwet” and in “Besluit zwangere werkneemsters” (in Dutch). Work that exposes you to vibrations (trucks, agricultural machines), ionizing radiation (radioactive substances), chemical substances or risks of infection can be harmful during pregnancy. This also applies to physically strenuous labour involving lifting(nursing etc.).
If your work is too strenuous for you, discuss this with your employer. Maybe your tasks can be altered or you can be given another position temporarily. You may also discuss this with the health and safety doctor (Arbo-arts). If you work on (night) shifts, you can ask your employer to change your work and resting hours. Being pregnant entitles extra breaks (every two hours a 15 minute break) and you are not obliged to work night shifts or do overtime. These rules also apply up to 6 months after the delivery.

Holidays
You can easily go on holiday whilst pregnant. Always take a print-out of your (pregnancy)-file with you (ask the assistant) This print-out lists your blood-results and the prenatal check-ups and these notes are internationally compatible. Choose a destination where suffi cient medical-care is available in case unexpected complications arise.

Only drink bottled water and eat pre-packed ice-cream, so no scooped ice-cream with whipped cream, in order to prevent infections. Do not buy food off the street and try to eat in ‘clean’ restaurants. We advise you to take ORS with you on holiday, in case you get diarrhoea. ORS is a mixture of sugars and salts and prevents dehydration. You can get ORS at your chemist or pharmacist.

From a medical point of view, there is no objection to fl ying. Ask for extra leg space on long fl ights, walk around every two hours, do some exercises and drink a lot of water. Check with your airline until when you can fl y, it differs per company. (for fl ights of over eight hours, please check with your midwife). Holiday resorts at high altitudes are not recommended because of the lack of oxygen in the air. Avoid staying above an altitude of 2150 metres.

Hospital delivery
All the deliveries under midwifery care take place in the hospital. We do not deliver babies at home.
Your insurance-company may ask you to pay an additional fee for a hospital delivery. Check this in time, so that you do not get any unpleasant surprises. The midwives will come to your home for the postnatal visits.
When you are approximately 36 weeks pregnant, you will receive a letter (during your prenatal check-up), informing you how and when to call the midwives when you begin to go into labour. This letter also informs you what to take with you to the hospital for both you and your baby.

Postnatal visits
Pre- and natal care is provided by the midwives. After the baby is born, the maternity nurse (‘kraamverzorgster’) takes over the care. The maternity nurse will be present for several hours every day. The midwife does not make daily visits and only advises when necessary. She does, however, visit you 2 or 3 times during the first week after the birth of your baby.

To get a complete picture of the condition of both mother and child, the (short) visit of the midwife is not enough. The daily observations of the maternity nurse are important and provide and provide a more complete picture. The maternity nurse will contact the midwife if problems arise.

At the start of your pregnancy, you must register with a ‘kraamcentrum/ kraambureau/office’. We also advise you to contact your health insurance company to ask with which agencies they do/do not co-operate. The assistant can provide you with a list of the maternity care centres/office in this area.

Please check if your insurance-company also works with these agencies, and register as soon as possible.

Breastfeeding
Breast milk is best for a new-born baby. Breast milk always has the right composition and the right temperature. Breast milk contains antibodies that will protect your baby from infections.

If you want to breastfeed, we will help you to feed your baby as soon as possible after birth, if the health of both mother and child allows this. The sucking refl ex is very strong in the fi rst hours after birth. The baby will look for its mother’s nipple and start sucking by instinct.
It is very important during the fi rst days to allow the baby to feed frequently (at least 8 times a day) to stimulate milk production. The fi rst milk is called colostrum. This is a sugar-, fat-, and albumen (power) food that contains large amounts of antibodies. Even if you only breastfeed your baby for a few of days or weeks, it still is worthwhile.

There are different feeding positions; sitting or lying down. The maternity nurse will teach you the position that is most comfortable for you and your baby. A certain amount of effort is needed to adjust demand and supply. We therefore advise you to prepare yourself whilst pregnant, by informing yourself about breastfeeding. You can do this by following a breastfeeding course. You can ask about this at your maternity care agency. You can also get the leafl et “Volop moedermelk” (in Dutch) from our assistant.

If you decide to bottle feed your baby we advise you to wear a tight bra after the delivery to decrease the pressure. The baby will receive it is fi rst bottle in the first hours after the delivery.

Things you need for you and your baby
Most insurance companies provide (free) maternity packages. We have made a detailed baby-care list for you. If you want this, you can ask for it during your visits. We would appreciate it if you would make sure you have the following things at home:

• sanitary towels
• cellulose mats
• digital thermometer
• bottle of alcohol 70%
• metal baby hot water bottle (at least 1, preferably 2) (if you borrow these hot water bottles, you have to provide a new closing rubber to prevent leaking)
• 2 packs of small gauze
• digital baby scale (you can rent this device if you intend to breastfeed your baby)

You can buy or hire these things at Vegro Thuiszorgwinkels:
- Vegro Den Haag,  Betje Wolfstraat 140-146
- Vegro Wassenaar,  Molenplein 1a
- Vegro Voorburg, Kon. Julianalaan 40
The Central phone number is (071) 406 06 00

Pregnancy courses
It is not necessary to take a pregnancy course to deliver “well”. We do hear from pregnant women that they felt supported by taking a course and from being in touch with other pregnant women. You can ask the assistant for a list of pregnancy courses at Bronovo or in the area.

Complaints procedure
In our practice, a great deal of attention is paid to good quality care. We make every effort to do our work as effi ciently and carefully as possible. However, human error can occur and this can sometimes lead to dissatisfaction.
The best way to deal with this is to speak directly to the person concerned or to the person in charge. If you are still not satisfied, you can submit a complaint to the Patients’ Ombudsman or the Complaints Commision. You can collect a leafl et on the complaints procedure at the Information & Documentation Office (‘Bureau Voorlichting & Documentatie’) in the Central Hall.

Contact / telephone numbers
Telephone consulting hours:

For questions about the pregnancy
Mon - Fri 08.30 - 09.00 hours,
phone number: (070) 312 40 63 / (070) 312 45 25

For making or rescheduling appointments
Mon - Fri 09.00 - 12.30 hours and 13.30 - 16.30 hours,
phone number: (070) 312 46 57

For emergencies or deliveries (24 hours a day)
Call (070) 312 4141 (central phone number of the Bronovo Hospital ) and ask for the “midwife on call”