Pregnant

An exciting time

You’re pregnant! An exciting time lies ahead for you and your partner. There is a lot to look forward to. Your body changes, your hormones are at work, and the relationship between you and your partner changes too. As well as partners, you are now also becoming parents.

Check-ups

First appointment

As soon as you know you are pregnant, you can get in touch with us. The first appointment takes place when you are 7–8 weeks pregnant and lasts about 60 minutes. We will ask you some questions about your health and your partner’s, any illnesses or conditions that run in the family, and any previous pregnancies and births. We ask these questions so that we can assess any risks properly and give you the best possible care. We will also tell you about the blood tests and the options for prenatal screening.

Follow-up appointments

Your follow-up appointments can take place together with other pregnant women, which is called Centering Pregnancy, or as one-to-one appointments. Centering Pregnancy sessions last 2 hours; one-to-one appointments last 15 minutes. If more time is needed, we plan 30 minutes. At every appointment we ask how you and your family are doing, emotionally and physically. Each time we check your blood pressure, keep track of your weight and measure the growth of your womb. We also listen to your baby’s heartbeat.

Later in the pregnancy we also check the baby’s position and whether the head has engaged.

You will come to see us:

• every 5 weeks until 20 weeks
• every 4 weeks until 28 weeks
• every 3 weeks until 32 weeks
• every 2 weeks until 36 weeks
• every week until the birth

If there is anything that needs extra attention, or if you would like to come more often, we will adjust the schedule. You are of course welcome to ask questions at every appointment.

Blood tests

At your first appointment you will receive a digital form to have blood taken between 10 and 12 weeks. You can have this done at the HAGA Hospital in Zoetermeer, among other places. You can go there any day between 8.00 and 16.15. These tests are done to prevent illness in your baby. If a test shows that the baby could become ill, it is often possible to treat you so that the baby is protected as much as possible. The results are sent to us. If a result is abnormal, we will let you know straight away. If the results are fine, we will discuss them at your next appointment. The blood tests look at:

• your blood group
• your rhesus factor (D and c)
• a number of antibodies against red blood cells
• syphilis (a sexually transmitted infection)
• hepatitis B (a liver disease)
• HIV
• your iron level
• your blood sugar level
• your vitamin D level

For more information about the blood tests, see the website of the RIVM (in Dutch). You pay a fee for having blood taken, according to the rates of the blood collection point or hospital where you go. You also pay a contribution towards the blood sugar and vitamin D tests. More information about the costs can be found on the website of the HAGA Hospital Zoetermeer (in Dutch).

Dating scan

At your first appointment we calculate your due date from the first day of your last period. To check that this date is right, we do a dating scan between 10 and 12 weeks, so that we know for certain when you are due. We can also see whether the heart is beating and whether you are expecting more than one baby.

Prenatal screening

During your first appointment we will, if you wish, tell you about the tests that are available. If you are considering one of these tests, we will invite you for a counselling appointment. This helps you get clear on your personal preferences and which test suits you best. The two tests are explained below.

The NIPT

As a pregnant woman you can take part in the NIPT as part of the national screening programme. The NIPT is a blood test. Your blood is examined in the laboratory to see whether your unborn baby may have trisomy 21 (Down syndrome), 18 (Edwards syndrome) or 13 (Patau syndrome), or other major chromosomal abnormalities. The NIPT can be done from 10 weeks of pregnancy. If you would like the NIPT, we will give you a referral. Please note: this is a separate form from the one for the regular blood tests.

You can book an appointment online to have blood taken for the NIPT. Your blood is then sent to the laboratory. We receive the result within 10 days, and we will contact you as soon as it comes in.

More information can be found at PNS.nl (in Dutch).

Further testing

Women with an increased risk result from the NIPT are given information about prenatal diagnosis by the prenatal diagnosis centre at the LUMC. This means an amniocentesis or a chorionic villus sampling (CVS) test. In CVS, a small piece of tissue is taken from the placenta. In an amniocentesis, about 20 ml of amniotic fluid is taken from the womb. These tests are only done when the chance of a baby with a chromosomal abnormality (such as Down syndrome) is increased, for example because you have had a child before with a condition that can recur. For more information about amniocentesis and CVS, see the website on prenatal diagnosis (in Dutch).

13-week scan

The 13-week scan looks for physical abnormalities. A physical abnormality means that part of the baby’s body looks different from normal. Examples are spina bifida, an open skull, hydrocephalus, heart defects, a hole in the diaphragm, a hole in the abdominal wall, or abnormalities of the kidneys or bones. You can have the 13-week scan from 12+3 up to and including 14+3 weeks of pregnancy. In the Netherlands you can only choose the 13-week scan if you take part in the IMITAS research study. This study looks at the advantages and disadvantages of the 13-week scan. On the one hand, it seems good to know early in pregnancy whether the baby has a serious physical abnormality: you then have more time for further tests and to decide what to do with the result. On the other hand, an early scan may also cause extra worry and uncertainty. Taking part in the study means that the researchers may use your data. You sign a consent form for this. Would you like to know more about the study, and about what happens to your data? See the PNS.nl website (in Dutch).

20-week scan

The 20-week scan is also called the anomaly scan (in Dutch: SEO). Its main purpose is to check for spina bifida or an open skull. The scan also looks closely at how the baby’s organs are developing, and other physical abnormalities may be seen as well. It also checks whether the baby is growing well and whether there is enough amniotic fluid. The 20-week scan is no guarantee of a healthy baby: not all abnormalities can be seen on a scan. The scan is not compulsory, but many parents do choose to have it. If no abnormalities are found, this can be reassuring. If an abnormality is found, you face a difficult decision. We will then refer you to Leiden University Medical Centre (LUMC) for a second scan. They can tell you whether there really is an abnormality and what the next steps will be. For more information, see the PNS.nl website (in Dutch).

Extra scans

Sometimes extra scans are needed, for example when the baby’s growth needs to be checked, or when the position of the placenta needs to be checked again. If there is a medical reason for extra scans during your pregnancy, we will tell you at one of your regular appointments.

Vaccinations

Whooping cough

During pregnancy you can also be vaccinated against whooping cough (pertussis). Whooping cough is a contagious disease caused by a bacterium. It causes severe coughing fits that can last three to four months. It often starts with symptoms that look like an ordinary cold, after which the coughing begins. This can range from an irritating cough to violent coughing fits, which can be so severe that they cause vomiting. The bacterium spreads through tiny droplets from the throat that get into the air when someone coughs. Whooping cough can be serious, especially in babies who have not been vaccinated or have not yet had all their vaccinations. In these babies it can lead to pneumonia, weight loss, breathing difficulties or turning blue, brain damage from lack of oxygen, and sometimes even death. On average, 120 babies with whooping cough are admitted to hospital every year.

As a pregnant woman you can choose to be vaccinated against whooping cough so that your baby is protected. This can be done from week 22 of your pregnancy until the birth.

The vaccine is available through the JGZ (youth health care service).

For more information, see the website of the National Immunisation Programme (in Dutch). You are of course always welcome to ask us questions during your appointments.

Flu vaccination

If you are 22 weeks pregnant or more between 15 October and 1 March, you can get a free flu vaccination. Flu can be more serious during pregnancy, and the vaccination also protects your baby in the first months after birth. More information is on the RIVM website (in Dutch).

RSV vaccination

RSV can cause a serious lung infection in young babies. That is why babies get a free RSV injection through the National Immunisation Programme. More information is on the RIVM website (in Dutch).