• If you are worried.
• If you don’t feel your baby moving well.
• If you lose bright red blood, similar to menstruation.
• For contractions: Is this your first baby? Call us when you have regular contractions every 4 minutes lasting 60 seconds for 2 hours. Have you given birth before? Call when you have contractions every 4 minutes lasting 60 seconds for 1 hour. This is just a guideline – every body and every pregnancy is different. Remember you can always consult with us!
• If your water breaks:
  Is your amniotic fluid white, transparent, or pink? That’s good news! Take a shower and try to sleep, then call us the next morning after 09:00. However, if the baby’s head hasn’t engaged yet, call us immediately, day or night. Also call us immediately if your amniotic fluid is green, yellow, or brown. This could mean your baby has passed meconium. If you get contractions, the above guidelines always apply.

Losing the mucus plug is unfortunately not a sign that labor is about to begin. You may lose this towards the end of pregnancy. This mucus plug is often very thick and has a dirty brown color. Sometimes it can also be slightly yellow.

Labor often begins with contractions. You might doubt whether it has really started. When labor has truly begun, the contractions will be regular and their intensity will increase over time. You can always try taking a shower. If the contractions decrease, they were probably practice contractions. If the contractions become stronger, it has really begun.

A contraction usually feels like a wave moving through your abdomen and/or back, from bottom to top. The characteristic of a contraction is that it starts gently, builds to a peak, and then subsides. Between contractions, you don’t feel pain.

Your water might also break without having contractions. It’s important to note the color of the amniotic fluid. Always try to catch some fluid in a glass or on white sanitary pad, so you can show the color later.
With brown, yellow, or green amniotic fluid, it’s important to call immediately, even at night. It means the baby has passed meconium in the amniotic fluid. From that moment, we want to monitor the baby’s condition more closely. As midwives, we don’t have the right equipment for this. Therefore, we will call the gynecologist, who will then continue to guide the delivery.
If your water breaks during the night and the color is white, clear, or pink, you can safely continue sleeping. Call us the next morning between 9:00 and 9:30 and tell us that your water has broken. If it happens during the day, you can call us immediately.
When your water has broken and you don’t have contractions yet, it’s important not to take baths, use tampons, or have intercourse.

The cervix is a ring of connective tissue that doesn’t (need to) open for nine months of your pregnancy. When you go into labor, contractions cause your cervix to shorten and open slightly (to three or four centimeters). This latent phase takes the most time and is characterized by regular contractions that are often still ‘manageable’. Try to find distractions during this phase, like folding laundry, baking a cake, or watching a movie.

The active phase begins at about four centimeters dilation; now you often need to breathe through the contractions. The contractions come quickly with an interval of four minutes and last about 60 seconds. When this continues for two hours, you should call us. Dilation progresses about one centimeter per hour. During this phase, you’re very concentrated on managing the contractions and finding a comfortable position. Listen to your body.

We will give you tips during this phase and monitor your baby’s condition closely. Around seven centimeters, you’ll need to make the final decision about going to the hospital or delivering at home, even if this differs from your original plan. Sometimes women feel so comfortable at home that they prefer not to leave, even if they had chosen a hospital birth. The opposite can also happen.

Wherever you deliver, try to stay as relaxed as possible. A shower, bath, or hot water bottle can help. Change positions regularly and drink and eat small amounts to give your body strength for the delivery.

When you reach almost ten centimeters, the dilation contractions will gradually change into pushing contractions. You no longer need to breathe through the contractions but start pushing. The baby is almost there, but this can still take some time. For a first baby, it’s not unusual to push for 1.5 hours. With a second or third baby, this often goes much faster. Choose a position that feels comfortable for you. We will help you with this if desired.

Congratulations, your baby is born! The maternity nurse dries your baby and places them on mother’s chest. We cover the baby warmly because we don’t want them to get cold. The umbilical cord is cut once it has stopped pulsating, and then we usually wait for the placenta. During the first hour after birth, the baby is alert with a strong sucking reflex. For this reason, it’s important to put your baby to the breast within the first hour, but only if you want to. After this hour, we will examine your baby, weigh them, and give vitamin K.

To promote the delivery of the placenta and limit blood loss, we give you an injection of oxytocin in your leg after delivery. This is the same hormone your body makes to induce contractions. The delivery of the placenta also involves contractions, but these are generally not as intense. Sometimes stitches are needed, which we can easily do ourselves with local anesthesia. If you had an outpatient delivery and there are no further complications, you can go home after two to three hours. Already at home? Then you can refresh yourself in your own shower, after which the maternity nurse will spoil you with traditional Dutch birth treats!

Remifentanil is a morphine-like substance administered through an infusion pump. You can control how much you receive with a button. Don’t worry, the pump is set so that you can never receive a dangerous amount. The substance doesn’t work long and is therefore only used for the last few centimeters.

Remifentanil works within a few minutes and is also cleared from your blood within a few minutes. It reduces the pain and helps you relax. You will still feel the contractions, but fortunately much less. Remifentanil can affect your breathing and blood oxygen levels. Therefore, you must be continuously monitored carefully.

The epidural is an injection in your lower back with a combination of different pain medications. The anesthesiologist inserts a needle into your back under local anesthesia. A thin, flexible tube is placed through the needle into your back. The needle is removed, but the tube stays in place. Through this tube, you receive pain medication throughout the delivery. Within 15 minutes, you’ll feel the pain becoming much less!

Advantages of an Epidural

• 95% of women feel no pain at all during contractions.
• As far as known, an epidural has no adverse effects on the baby.
• You don’t become drowsy or sleepy from an epidural and therefore experience the entire delivery.

Disadvantages of an Epidural

• Sometimes an epidural only works on one side.
• In about 5% of women, the pain doesn’t decrease or barely decreases. This can be due to the placement of the needle and the dosage of the medication. The epidural is sometimes repeated.
• The delivery, especially pushing, takes longer. This increases the chance of a delivery with vacuum extraction.
• Contractions more often need to be supported with medication.
• You can’t leave your bed because you have less feeling in your legs. This gradually returns after the medication is stopped. With a low dose, you have more feeling in your legs and can sometimes stand, walk, and push.
• An IV is inserted to prevent low blood pressure.
• Every few hours your bladder is emptied with a catheter because the anesthesia prevents you from feeling when you need to urinate.
• Your body temperature may rise due to an epidural. It’s then difficult to determine whether this is due to the epidural or fever from an infection. You’ll receive antibiotics as a precaution. After delivery, your baby must be observed for 24 hours to monitor for fever.
• You may experience itching. This can be well treated by adjusting the medication composition.