Pregnancy

Congratulations on your pregnancy! An exciting and beautiful time has started! It’s also a time that will bring along big physical and emotional changes.

Here you will find all the information about our care during your pregnancy. You can find information on the pregnancy check-ups, the medical tests available to you in your pregnancy, a healthy diet and lifestyle, pregnancy classes and everything you need to arrange regarding your pregnancy.

First appointment

Around 7 weeks pregnancy we happily welcome you at our practice for your first check-up.
At this first check-up – which takes around 30 minutes – we will, after a short introduction, perform an ultrasound. The goal of this ultrasound is to see whether we find a pregnancy with a positive heartbeat, whether there’s one or more babies, and whether it’s not an extra-uterine pregnancy. We will also do a measurement to estimate how far along the pregnancy is. After the ultrasound we will give you relevant information about your pregnancy and you will have time to ask us questions.

Make sure to drink 2 large glasses of water before your appointment, this increases the chance of being able to perform the ultrasound abdominally. In early pregnancy, if we’re unable to get sufficient imaging abdominally, it can sometimes be necessary to perform the ultrasound vaginally (only with your consent of course).

Second appointment

Around 9 weeks pregnancy we will have a second, longer, appointment, taking around 60 minutes. This appointment can take place at our practice or in your own home. We will ask you a lot of questions and give you a lot of information, and if you wish we can perform another ultrasound.
During this appointment we will discuss your medical history, the health of your partner and family, and any previous pregnancies.

Your lifestyle as well as that of your partner can be of influence to your pregnancy, so this will also be discussed. Possible topics are smoking, alcohol use, exercise and dietary habits.
During your pregnancy a numer of tests are available to you to screen for congenital defects. These are screening tests for chromosomal syndromes and the 20 week structural ultrasound. These tests will be discussed during this appointment.

Following appointments

The remaining appointments will take place according to the following schedule:

10 to 12 weeks: Ultrasound to determine your expected date of delivery
up to 24 weeks: A check-up every 4 weeks
24 to 30 weeks: A check-up every 3 weeks
30 to 36 weeks: A check-up every 2 weeks
after 36 weeks: A check-up every week

 

This is the minimum number of check-ups we will perform. We are aware that every pregnancy is different. If you prefer to be seen more often, this is always a possibility!

It can also be necessary to be seen more often for medical reasons.

Check-ups take around 30 minutes and can take place at our practice or in your own home. A regular check-up consists of a conversation and a physical examination. We will discuss how you’re feeling, provide information on how your pregnancy is going and give you advice on any symptoms or problems you might have. The physical examination means we will measure your blood pressure, feel your belly to assess the growth and position of your baby, and listen to your baby’s heartbeat. If you wish, we can also have a quick look at your baby through ultrasound.

Prenatal testing

Ultrasounds

7 weeks: This ultrasound is aimed at seeing whether there is a heartbeat, whether there’s one or more babies, and whether there is no extra-uterine pregnancy. We also use this ultrasound to estimate how far along your pregnancy is. This ultrasound takes place at our practice.

10-12 weeks: Between 10 and 12 weeks pregnancy we will perform an ultrasound to determine your estimated date of delivery by measuring your baby’s crown-rump length. This ultrasound takes place at our practice.

18-22 weeks: Between 18 and 22 weeks pregnancy you can choose to have an extensive ultrasound to screen for physical congenital defects. This ultrasound takes place in a specialized centre, either at the hospital in Maastricht or at “’t Lichtpunt” in Nuth. Should you choose to undergo this test, we will arrange an appointment for you. For more information on the “20-week ultrasound” click here.

32 weeks: Around 32 weeks pregnancy you can choose to have an ultrasound to assess your baby’s growth. In this ultrasound the baby’s head, abdomen and legs are measured. This ultrasound takes place at our practice.

36 weeks: Around 36 weeks we can use the ultrasound to assess whether your baby is in a head-down position. This ultrasound takes place at our practice.

A few times in your pregnancy we will perform blood testing.

12 weeks: At your second appointment we will give you a few forms to have blood drawn. This can be done through your family doctor or at the hospital in Maastricht. We ask you to have this blood drawn before 13 weeks pregnancy. Your blood will be checked for your blood type, rhesus factor (D and c), irregular antibodies, haemoglobin, glucose, and infectious diseases HIV, hepatitis B and Lues.
We will discuss the results of this blood test at your following appointment. If there is any reason to inform you of the results earlier, we will of course do so.

30 weeks: At 30 weeks we will take a small amount of blood from your fingertip to check your haemoglobin- and glucose level. This takes place during one of your regular appointments at your practice or in your own home.

Blood testing when your blood type is rhesus D and/or c negative: If your blood is shown to be rhesus D or c negative, we will repeat blood testing around 27 weeks pregnancy. This takes place during one of your regular appointments at your practice or in your own home.

The nuchal translucency and serum screening is a test available between 11 and 14
weeks pregnancy, aimed at determining the odds of your baby having trisomy 13, 18 or
21 (Patau’s syndrome, Edwards’ syndrome or Down’s syndrome).
The test consists of an ultrasound to measure the nuchal translucency (a skin fold in the
baby’s neck) and a blood test. The results of this, together with your age, will be used to
calculate the chance of the syndromes named above. This test is safe for you and your baby.

If your personalised chance is calculated to be at or above 1 in 200 (for instance, 1 in
50), you have a right to do further testing. One of the options for further testing is the
non-invasive prenatal test (NIPT).

Most health insurance policies do not cover the combination test. The costs are around €175. This test takes place in hospital and requires a referral from us.

For more information on the combination test click here.

The NIPT  (non invasive prenatal test) is a test which extracts your baby’s DNA from your blood. This DNA material is then tested for signs of the crhomosomal disorders trisomy 13 (Patau’s syndrome), trisomy 18 (Edward’s syndrome) and trisomy 21 (Down’s syndrome). The test is safe for you and your baby.

The NIPT can be done as a follow up test after the combination test, or as a primary screening test.

The test result can be normal or anomalous. The test does not provide 100% certainty, so in case of an anomalous result an amniocentesis is necessary to confirm (or negate) the findings.

Most test results are normal. In this case the chance of having trisomy 13, 18 or 21 are so small (<1:1000) that follow up testing is not advised.

Costs of the NIPT are partially covered by your health insurance. You have to pay the remaining €175 yourself. The NIPT takes place in hospital and requires a referral from us.

For more information on the NIPT click here.

In your pregnancy you have the option of undergoing a fetal anomaly ultrasound. Also known as the 20-week scan, this is an ultrasound examination that takes place between 18 and 22 weeks at a specialised ultrasound centre. This can be at the hospital in Maastricht or at “echocentrum ‘t Lichtpunt” in Nuth. You will need a referral from us to have this ultrasound.

With this test your baby will be scanned top to bottom for physical anomalies. Amongst other things, this test screens for spina bifida, defects of the arms and legs, heart defects etc. Your baby’s growth, the amount of amniotic fluid and the location of the placenta will also be assessed. A lot of anomalies can be found in this ultrasound, but this doesn’t provide a guarantee of a healthy baby. It is important to keep in mind that not all defects can be seen.

For more information about the 20 week ultrasound click here.

To-do’s

Kraamzorg

A kraamzorg nurse is a home care nurse specialised in caring for newborn children and their mothers. They will come to your house for a number of hours each day in the first week after birth. They keep an eye on your health and the health of your baby, and will assist with breastfeeding as well as light household work. If you deliver at home or in the hospital with one of us, the kraamzorg nurse will support us during your delivery as well.

It’s important to apply for kraamzorg ahead of time, preferably before 16 weeks pregnancy.

Family doctor/pharmacy

Inform your family doctor and your pgarmacy of your pregnancy, so that they can take it into account when prescribing medication.

Health insurance

Inform your health insurance company of your pregnancy. Your health insurance will cover midwifery care completely and kraamzorg for a big part. With most health insurance policies you will receive a box of necessities for your delivery and the days after. Inform with them whether they will provide this. If they do not, we can inform you about what to buy and where to find it.

Acknowledgement of parenthood

If you’re unmarried and don’t have a civil partnership, your partner can choose to officially acknowledge parenthood. This is needed if you want your baby to have your partner’s name and your partner to have parental duties. Acknowledgement does not automatically grant joint responsibility of the child, this needs to be applied for after the baby is born.

Employer

Inform your employer of your pregnancy. Legally you are required to inform your employer at least 3 weeks before your due date. However, it is more practical to inform them earlier. You will be given a declaration of pregnancy by us, wich can be used to arrange your maternity leave.

Childcare

It can be wise to arrange childcare early on during your pregnancy, as childcare facilities may have long waiting lists.