Labor
Between week 37 and 42 we can help you giving birth to your baby. If the baby comes before this time the hospital will take over.
Before labor the next symptoms may occur:
Hard bellies & pre-labor contractions & descending contractions.
These are contractions of the uterus which are not (much) painful. They come irregular and disappear when you rest. They can be quite inconvenient. Usual they come when you are too busy or have a lot of stress. So…slow down. Inflammation of the bladder can also give contractions.
Hard-bellies are more common at the end of your pregnancy and are harmless.
Pre-contractions are more painful and more common at the end. They don’t last long, about 20 to 30 seconds and can keep coming for a couple of hours. This happens mostly at night. They don’t open the uterus but make the opening more soft and tender.
Descending contractions are often low in the belly or vagina and will disappear after some time. For some it can be awkward others feel nothing.
Start of labor
Labor can start in 2 ways. The membranes can rupture or contractions start coming. So much is happening when labor starts.
Imagine your uterus is a balloon. The cervix or opening is the nipple:
The first phase of labor is called “the latent phase ”. Contractions make the opening flexible and soft. It will become shorter and shorter until it is completely flat. The uterus then starts to open. This phase can take several hours if contractions are not yet very strong.
Labor can also start because the membranes rupture. If so, check the color of the water. If the baby has defecated the water will be green or brown. If this is the case we will take you to the hospital and the midwife in the hospital will take over care. Continuous registration of the heartbeat of the baby is then required. Most of the time contractions start within 24 hours after rupture of the membranes, but sometimes nothing happens. Then also, hospital will take over care. We will take arrange that for you.
Active phase. In this phase contractions come every 3 minutes lasting 60 seconds. When the uterus has opened 5 cm. we will go to the hospital if that’s the place where you prefer to have your baby. It’s also called “ a poliklinische bevalling ”. When you have 10 centimeters dilatation the baby can start to come down for the last phase.
When dilation is 10cm. The head of the baby will start pushing down and you will feel the urge to press. Now the past phase is starting. Average it takes 1 hour to push the baby out.
When we come to your house we will first observe you to get a good idea of what is going on. We will check the position and growth of the baby and listen to the heart beat. When we think labor has started we will check by vaginal examination if and how far the uterus has dilated. If it is more then 5 cm we will go to the hospital with you. Do you want to deliver at home we will call a nurse to assist us.
when to call us
If , before 37 weeks, you have contractions, blood loss or loss of amniotic fluid…..call us.
Is it your first child?
- Call us when you have contraction every 4 minutes for 2 hours. The contraction lasts 1 minute.
- When you lose amniotic fluid and the head of the baby is not yet deep enough. Call us. Check the color of the water. Call us always when it is green.
If it happens at night and the color is clear, then call us the next morning. - A little blood loss is no problem, only if a bandage is full in 10 minutes it is not okay, call us.
- Call us when the baby is not or much less moving than normally.
Is it your second (or more) child?
Call instructions are the same. Only the baby often comes a bit quicker so call us when you have strong contractions every 5 minutes. Also call us when you are worried that the baby is moving much less than usual.
At home or poliklinisch delivery
When pregnancy is without complications you can choose where you want to deliver your baby, at home or in the hospital. Choose the place where you and your partner feel most comfortable. If you choose the hospital and there is no medical need you have to pay part depending on how your health insurance covers the costs. Homebirth is always fully covered.
At home
The advantage of staying at home can be that you feel more comfortable in your own home. When there is sufficient progress we will stay with you all the time. We will call the postnatal nurse to assist us. As long as everything is alright we will stay at home, but sometimes it is necessary to go to the hospital. We then call the hospital and take you there.
So make sure you have a “ kraampakket ” from your insurance ready and a small suitcase with clothes for you and the baby in case we have to go to the hospital.
When everything goes well, the postnatal nurse will stay to help you nourish the baby and see to it that you are bathed
Poliklinisch in het Amphia Molengracht
You can choose to have your baby in the hospital. When there is no medical need, we call it a Poliklinische bevalling. When you are in labor we will first visit you at home to see how far the progress is. Together we will then decide when to go to the hospital. We will call the hospital and a postnatal nurse to assist us in the hospital. Together we will go to the hospital. You must have your own means of transport. Bring a 1 euro coin for the wheelchair at the entrance of the hospital. Together we will go to the obstetric department.
At www.annature.nl you can see how to follow route 28 to the obstetrics.
At www.annature.nl you can also see what possibilities of pain relief can be given in case you should need this.
In the hospital we have 2 rooms with a bath. It helps to relief the pain when you are in labor.
You, your husband and the baby will always be together in the same room. Also when there are medical complications.
Medical complications
When we see something is not good, we contact the gynecologist and then they will take over all care. The midwife of the hospital will then help you most of the time together with the gynecologist and a medical assistant.
Geboortewensplan
At one of your prenatal consultations we will ask if you have any special wishes when you will be in labor. For example about pain relief, number of people in the room, atmosphere, positions when pushing the baby out. We will write down your wishes in your medical file so that the midwife who helps you knows your wishes.
Want more information on this? Then go to the website: www.deverloskundige.nl
Painrelief
Breathing and relaxation exercises will help you during delivery. When you are calm your body will release Endorphins. Endorphins ease the pain. We will help you with these exercises.
With continuous support, a vertical position during the dilatation phase (walking or sitting), change of position a bath or warm shower will increase the dilatation of the cervix and will make medical pain relief less needed.
If you want or need pain medication, we always have to go to the hospital. When you get pain medication the heartbeat of the baby needs to be monitored all the time and also blood pressure and saturisation of the mother need to be checked.
Options for pain medication are:
- Ruggenprik or Epidural
- Pump with Remifentanil
- Relivopan or Lachgas
Please look at www.annature.nl for more information. Or check www.deverloskundige.nl
We will guide you to the hospital. First the heartbeat of the baby needs to be checked for half an hour. The midwife of the hospital will then offer you one of the above options.
Free choice
There are many different ways to have your baby. As long as you and your baby are okay you can choose whatever you want. Let us know what you want. Only when it is medically not good we will talk to you about other options.
Advantage of changing position:
- Women experience less pain
- Less need for medical pain medication
- Labor is 1 hour shorter compared to lying down
- More control. You feel less dependent than when lying down
- Pushing is less painful and gives shortens births last stage
