At Around 7 weeks you have your first echo at Focus. Call us so we can make that appointment for you as soon as you are pregnant.

Your first visit at our practice will be when you are around 8 weeks pregnant. It takes about 45 minutes. At this appointment we will get to know you better and will ask you questions about the health of you and your family. At www.pns.nl you can find the list of questions. Is it not your first pregnancy, then we want to hear more about that pregnancy, birth and postnatal period of your ither children. We will give you information about what to eat (check the Zwangerhap app.) We will give you all the information about the NIPT and de 13 and 20 week echo. At our Breda location we will also make an echo. When you are 10 weeks you will have the next echo/ultrasound. It’s is called a “ termijn echo” and will determine the due date. Please call us the next morning after the echo and let us know this due date so we can order the 13 week echo.

At 12 week you come to the praxis again for check-up. We then give you the lab form for the NIPT if you want to do this test.
Prenatal consultations are in week 8-12-16-19 (echo)- 23-27-30-33-36-38-39-40-41.
Every consultation we check your blood pressure and weight. We check if the baby is growing well and we listen to the heartbeat of the baby. At our Breda location we check it with our new echo machine.

Questionnaire on your health and that of your family:

Do you consider yourself healthy or do you ever visit a GP or specialist?
If so what diseases do you have or what have you had surgery on?
Do you have any congenital defects yourself?
Have you ever suffered from thrombosis, bladder infections, fungal infections, anaemia, blood transfusion or chicken pox?
Have you ever had a negative sexual experience or experienced domestic or physical violence?
Have you ever been treated for an STD?
What medications are you taking?
What allergies do you have?
Do you smoke and/or use alcohol or drugs?
Have you ever seen a psychologist or a psychiatrist?
Is your partner healthy?
Does your partner smoke or have allergies?
Does he/she have birth defects?
The health of both families
Does either of your families have a congenital or hereditary condition? For example, syndromes or intellectual disabilities, spina bifida or skull, disorders of brain, nervous system or muscles, lip and/or palate cleft, heart defects, sickle cell disease, thalassemia or haemophilia (blood diseases) etc?
Do any of your parents or brother/sister have diabetes or high blood pressure?

All the information we receive comes through the mother: how she is doing, how healthy she is, how she feels, the contact there is with the baby, the baby’s growth and the baby’s movements. Every woman experiences this in her own way and this is not always easy to measure. That is why we also use figures from studies done on other pregnant women. It is important that you make a choice that is right for you. This information leaflet shows you the options we offer.

First read the consultation card you received from your healthcare provider. It lists the main pros and cons of the choices you can make.

In this folder you can read about the possibilities in your region with figures that can help you make a choice.

Waiting for labour to start on its own is a safe choice. However, it is important that your pregnancy has gone without complications, your baby has grown well and you feel your baby moving well every day. You can have extra check-ups if you like. If you have not gone into labour at 41 weeks, the chances of labour starting on its own before 42 weeks are about 64 in 100 (see diagram opposite). You are less likely to have interventions during labour and be handed over to medical providers in the hospital. You can also choose where you want to give birth. Besides, every week in the womb contributes to better brain development of the baby.

The chances of giving birth are increased if the midwife releases a small piece of membrane from the uterine wall during a vaginal examination. This is called ‘strippen’. There must already be some dilation to reach the membranes. As the membranes detach a little bit, hormones are released. These hormones can be the last step to start labour. If ‘strippen’ works, you will have contractions within 20 hours. Strippen can be repeated after a few days.

Labour is more likely to start on its own before 42 weeks in pregnant women who get a membrane sweep: 68 out of 100. Pregnant women who do not get a membrane sweep are 54 out of 100. An introduction is therefore needed less often if you get a membrane sweep. These figures come from a study where a membrane sweep was done every day or every other day from 41 weeks.

If labour does not start and you have it induced with medication in hospital, it is called an introduction. You can read more about this in the consultation card you received. In the information below, you can also read and see what the figures were in the Netherlands for pregnant women who were initiated at 41 or 42 weeks.

If your pregnancy keeps getting longer, there may come a time when you want to have your labour induced. The hospital midwife may try to break the membranes. The waters can only be broken if you already have some dilation. In 85 out of 100 pregnancies, labour then starts on its own (see diagram opposite).
In addition, medical interventions such as tranquillisers or painkillers are less often needed and you are more likely to be able to give birth at your preferred location.
If the waters are broken and it turns out that the baby has defecated in the amniotic fluid (meconium-containing amniotic fluid), the baby’s heart tones are additionally monitored with a cardiac video.

If it is not yet possible to break the membranes and you want to be induced, the cervix will have to be prepared first. This is done by inserting a thin catheter into the cervix and then injecting fluid into the catheter, creating a balloon catheter that will stretch the cervix. After one or more days, the balloon catheter will fall out of the cervix and the hospital midwife can break your waters. Placing a balloon catheter is very safe. Little research has been done on the likelihood of contractions starting on their own. In a small group of pregnancies where this was already used once in the Netherlands, 87 out of 100 pregnancies went into labour by themselves after the waters broke. Among the pregnant women who went into labour for the first time, 23 out of 100 gave birth after balloon induction without the need for inducing contractions. Among the pregnant women who had given birth before, 48 out of 100 gave birth. Further research is yet to clarify exactly how much chance you have of giving birth without intervention after balloon catheter insertion.

The numbers you see below are from the INDEX study. This was a study conducted in the Netherlands. In this study, half of the pregnant women were assigned by chance to a group in which an introduction was planned at 41 weeks. The other half were assigned to a group in which an introduction was scheduled at 42 weeks. The choice you get to make is at what point you want to be initiated from 41 weeks.

This could be at 41 weeks, somewhere between 41 and 42 weeks, at 42 weeks, or after that. The choice is yours and in consultation with your healthcare provider and may also depend on the amount of space in the hospitals.

Of the pregnant women who were assigned to be initiated at 41 weeks, in 29 out of 100, labour started on its own. Among pregnant women who waited until 42 weeks, 74 out of 100 went into labour on their own.

Oxytocin is a drug that induces or makes contractions stronger, and like any drug, it also has drawbacks. Oxytocin was more often given to pregnant women who were due to be initiated at 41 weeks, 59 out of 100. This was the case for 39 out of 100 pregnant women who were due to be initiated at 42 weeks.

Among pregnant women who were to be initiated at 41 weeks, serious outcomes for the child were slightly less frequent, at 1 out of 225. Among pregnant women who waited until 42 weeks, it was 3 out of 225. This difference could be due to chance, as it involved few children. A serious outcome for the child could include a poor start, death, damage to the baby or admission to intensive care.

Of the 900 pregnant women who were due to be initiated at 41 weeks, 1 baby died. Of the 901 pregnant women who waited until 42 weeks, 2 infants died. This difference was probably due to coincidence. In fact, the number of children dying was very low in both groups.

If you have any questions, feel free to discuss them with your obstetric care provider. There is no right or wrong decision about whether to initiate or wait. Trust your own wishes and preferences.

Useful websites to visit are:
Annature.nl
Deverloskundige.nl