Childbirth Preparation Course

Truus Gale
www.childbirthclassgale.com
 Truus Gale
• Midwife for 35 years in
Haarlemmermeer
(23 years practising)
• Founder and operator Childbirth
Class Gale since 2005
• Group sessions and private
consultations
• Lecturer several colleges
• Well travelled
• British husband/ 2 adult kids
• childbirthclassgale@gmail.com
• 06-54 97 78 78
 Programme of course
Lesson 1
Introduction, getting to know each other, contact list
The Dutch health system and childbirth
Changes in the body, preparing process
Dilation, breathing 1st stage of labour

Lesson 2 Bring: two tennis balls in sock

Membrane rupture. How to stimulate labour

Breathing and massage exercises in different position
and stages of labour and how partner can support
Attitude towards contractions and pain
Pain relief possibilities
 Programme of course
Lesson 3 bring a small comb

More tools to cope with labour

Induction when and how
Instrumental delivery, C section
Helping you to make informed choices and handle
your concerns. Group discussion.

Lesson 4 Bring a non-strechy scarf. Ladies: no miniskirt

Pushing stage: what happens in your body

What are the possibilities
Pushing and panting exercises in different positions
Film water birth
 Programme of course
Lesson 5 Bring some drinks or a snack
The GOLDEN Hour: bonding with baby
Kraamzorg in the Netherlands
What to do: Postpartum depression
Dutch habits and customs
Rehearsal / interactive timeline puzzle
Plan date and location for postnatal reunion

Lesson 6: bring baby

Postnatal reunion on a Saturday 6 weeks
after last baby has arrived
Place to be discussed (your home? Who wants to host?)
Pregnancy is not an illness
You are designed for it!

But treat it with great respect

 Hierarchy in caretakers around birth

Highly
specialized care
3rd line

Obstetrician Pediatrician
2nd line 2nd line

Midwife Consultatie-
Family doctor
Kraamzorg/doula bureau
1st line 1st line 1st line
FACILITIES
Boven
IJ

Spaarne
Gasthuis OLVG
WEST
(BCW)
OLVG
OOST

AMC

AMSTELLAND
Amstelveen

8
Beval Centrum West (within OLVG WEST)

virtual tour:
www.bevalcentrumwest.nl

Birthing pools

Gas and air

• OLVG East
Location VU
• OLVG West Location AMC
 What is a midwife

• 4 years full time trained medical

professional
• Works independently in own practice or is
employed by the hospital
• Often more midwives together in one group
• During her study he/she has a lot of
practical experience
• Knowledge about pathology
• Fully equipped for home birth (including
oxygen, medicine, stitching, heart monitor)
• Trained to select and refer to obstetrician if
more care is needed
 Role of a Dutch midwife

• Prenatal check-ups, prevention

• Selection in pregnancy and during
birthing process (according to VIL list)
• Low and medium risk birth (home or hospital)
• Visits to the newborn and mother (10 days)
• Check-up after 6 weeks
 Role of a Dutch obstetrician

• Specialised doctor in gynaecology:

obstetrics
• Works in hospitals
• Specialized in high risk pregnancies
and deliveries
• Trained to take over from midwife if
woman in labour needs more care
• Trained to do interventions when
needed
 Role of a doula
• Doula means (in Greek): “woman of
service” . Helps women and the
partner during labour.
• Prepares you in pregnancy
• She can support online in between
visits of midwife.
• (Student €200-€500, certified € 750.-€1200)

• www.doula.nl ask me email addresses for student

doula’s or look at link page website
• https://childbirthclassgale.com/links/
To doula or not to doula
 What does insurance cover
Homebirth is fully covered
Hospital room rent for birth
without medical condition:
costs are not always covered in Basic insurance

All Midwifery care: fully covered

All Medical care: fully covered
Kraamzorg: Own personal contribution is €4 per hour
Ambulance from home to hospital, check insurance policy
Lactation consultant: check your insurance policy
Doula: check your insurance policy
 After 2 weeks:
A second visit from health visitor at home

You are automatically enrolled

in the health system after you register your baby within
three days of birth. (If not married: recognise the baby)

Consultatiebureau =baby doctor

 Growth guide (“Groeigids”: ask for English version)
 Weight and development of baby every month
 Vaccination
 Doctor and nurse until 4 years old

Emergencies
 Family doctor> Huisartsen post
 Progesterone effect
Makes tissue weaker from outside and inside

Skin: oedema, striae, carpal tunnel

Intestines: constipation, haemorrhoids
Sphincter: bladder, stomach (heartburn)
Joints: instability of pelvis
Brain: forgetful, slow, dreamy
Blood vessels: varicose veins, cramps,
nosebleed, gums, cervix, warm, dizzy
Tired: this is all normal!
 Stages of Birth
First: Dilation:
Ripening of the cervix: 7-8 hours
Active stage: (10-24 hours)

Second: Pushing stage

(10 min-2 hours)

Third: Afterbirth: birth of placenta

(10 min-1 hour)
“normal labour” (birth chart)
 Beginning of labour

Normal time: 37-42 weeks

Only 3% delivers on due date

Between 41-42 weeks labour will be

induced

Any signs of labour <37 weeks:

Call midwife/obstetrician
 The first few hours of
labour

The cervical tissue becomes

soft, weak and disappears in
order to open up, this
happens in the latent stage of
labour
Focus more on progression than on cm
Visualise your dilation
Dilation from 4-10 cm

• After the latent

stage (when you
reached 4 cm
dilation)
there is the active
stage, more
intensity, use the
tools you learned
Difference between a contraction
and Braxton Hicks: a contraction is much
stronger and will continue in a pattern (not always)
 Mucous plug

You can lose mucous plug a

week or a few days before
labour; or at beginning.
You don’t have to call midwife
for this, unless it happens before
37 weeks and you have
contractions
 How to recognise latent
labour

• Losing bloody mucous (not always)

• Irregular contractions every
15 min - 10 min - 7 min - 5 min
• Contractions last 20-30 or 40 seconds
• Not very painful but uncomfortable
• Does not stop after relaxing
 What to do
in latent phase?

• Don’t wake up your partner!!

• Stay in bed, try to sleep in between
• Rest as much as possible: safe energy
• During daytime: find distraction
• Realise: just preparing process
• You do not have to call the midwife yet
• Stay calm by deep breathing
• It is possible you get a bit nausea
 Why breathing in pain?

• To influence your natural reaction

• Softener of the pain
• Prevents anxiety and panic
• Prevents hyperventilation
• Helps staying in control
• Relaxing……….endorphins will be released
• Prevents pushing when not allowed
• Saves a lot of energy
 Important hormones at
birth
1. Oxytocin:love, bonding

2. Endorphins: transcendental, relax

3. Catecholamine: excitement

4. Prolactin: mothering/breastfeeding
 BREATHING exercises

1. DIVERTS THE BRAIN

2. RELAXING

3. HYPNOTISE YOURSELF

4. EXELLENT TOOL

See separate handout with breathing exercises.

 Deep breathing in latent
stage
• Inhale through nose
• Blow up belly like balloon
• Exhale lóóóóng, and slow
through nose or mouth
• Relax pelvic floor
• Stay calm
• Realise: this is just the
preparing process
• You need the
contractions to open See separate handout
• Stay connected to your
baby
• Take a shower or bath
Childbirth Preparation
Course ACCESS
Lesson 2
 Rupture of amniotic water

90% when in labour, any stage

10% before contractions start
 Membrane rupture
• Can be a lot of water at one time or
just a few drops
• Try to catch some fluid in glass
or plastic sandwich bag
• After 24 hours referral to hospital if
water is clear and no contractions
• After 48 hours induction or antibiotic
(each hospital has its own protocol)
Colour of amniotic water
(like diluted milk, cloudy)
Pink amniotic water:
drops of blood
 When do contractions start
after water has broken?
• 60% starts < 24
hours

• 95% < 72 hours

No difference in
neonatal infection
if you wait for natural
contractions or
induction

• Bit more in the bath

 Green amniotic water
(meconium)

(is pooh of baby, looks like the Dutch pea soup

baby needs monitoring/call midwife)
 When to call when membrane
ruptures

• Immediately:
• Green amniotic water = pooh of baby
Baby needs monitoring
• When contractions start or membrane ruptures
before 37 weeks
• Membrane rupture when head is not engaged
• More than few drops of blood

• Call next morning:

• Clear amniotic water when head of baby is
engaged, few or no contractions
 Het Kraampakket: maternity kit

Check with insurance company.

Check handoputs “What do you need “
 When to call with contractions
First child:

• For two hours contractions every 3-5 min

• Contractions last one minute and are painful
• You need your breathing exercises

2nd, 3rd child:

• Contractions every 5 min, lasting one minute

• You recognise: this is it.
• Be prepared, everything can happen much faster

NOTE: every midwife/hospital gives own instructions

 Decision tree first baby after 37 weeks

NOT YET Breathe, relax,

massage and wait
Every 3-4 minutes + 1
Contraction
minute long for 1-2
s start
hours?
90% cases
Call day
Call midwife or night
YES

NO Call midwife Midwife will do check-up and give

instructions (no bath). After 24h no
next morning contractions> referral to hospital →birth
(Go back to sleep) induced
Color
white/milky or Contractions? wait 1 hour
Call day
pink/rosé? Mild, irregular to call or night
midwife
Water YES Regular,
Call Call day
breaks strong, every 5 or night
midwife
10% cases minutes
Color any Call day or night, with or
Call midwife
shade of without contractions.
immediately Medical staff will take
green? over responsibility
 What will the midwife be doing
when she comes

• Observing the contractions and see

how/if you cope
• Feeling the position of the baby
• Listening to the heartbeat of the baby
• Internal examination
• Planning the way ahead:
Midwife will call kraamzorg in case of
home birth, or she will ring a hospital,
Bevalcentrum or Birth Clinic
 Information from an
internal examination

• Cervix (weak,tough)
• Dilation (cm)
• Membranes
• Engaged how deep
• Position of
head/breech
• How strong
contractions are
 What do you need to get
good contractions

• Release of hormone OXYTOCIN

• And: RELAX
so the oxytocin can do its work

• REALISE what is going to happen:

the baby has to come out
So you need the contractions to open up
Contractions are your FRIENDS
Without contractions, no opening of cervix.
How to stimulate labour?
Release more oxytocin

Oxytocin is
The love
cuddle, bond
hormone
 How to recognise
dilation contractions
(active phase)
• You can’t cope with deep breathing
• Contractions every 3-5 min
• Contractions last for one minute
• Powerful, need your exercises
• Possible loss of blood or amniotic fluid
• Nausea(possible)
• When to call?

• When you have (all) this for 1or 2

hours (own midwife will instruct you)
How to relax and what helps
shower, bath, massage, breathing
 How to relax and help
shower (> 20 min) bath, massage,
breathing, moving

53
 Make room for the baby
The baby has to pass more than just the bony pelvis
keep soft parts of pelvis flexible
Sitting on fit (birthing) ball?

Hips higher than knees

Beneficial for position of the
baby. Less chance for
‘stargazing’ position.
Ball should not be too small
(75 or 85 cm)
 Walk around the bed
even when attached to machines

In bed is more painful.

When you move baby can find the best way out
 Two different kind of
breathing in 1st stage
1.Passive phase: (preparing process)
deep breathing, stay calm, ignoring,
resting, save energy, distraction.
(contractions are not so strong yet)
2.Active phase: (dilation is happening)
interval breathing, walking, dancing, in
the shower, bath, massage of back, hot
water bottle, bending over pillow/bed
(strong contractions)
 Interval breathing in active
stage (do SLOW breathing as long as possible)
– Inhale through nose
– Exhale through mouth with
intervals. Last one is lóóóng
– Start as calm as possible
(maybe only 1 or 2 intervals)
– Visualise what is happening inside
– Connect with baby
– Think of a positive line: I need to
open up… ...I am very strong……
I can do this….
– Partner helps her breathing,
especially to help her go back to
normal breathing in the pause
 Make your own sound

Make a low deep

sound when you
exhale, it really
helps
Hum with music

Relax pelvic floor

RELAX JAWS
FIND YOUR
BIRTHING
MANTRA!

‘I am ready, I am open ,
I can do this’
 Learn how to swim

Stay in control
by breathing

Be tough
 How pain works
“To diminish the suffering of pain, we need to
make a crucial distinction between the pain
of pain, and the pain we create by our
thoughts about the pain.

Fear, anger, guilt, loneliness and helplessness

are all mental and emotional responses that
can intensify pain.” –

Howard Cutler
 3 components of pain

1. Sensory experience (physical pain)

2. Affective experience (emotions)

(often negative emotions)

3. Cognitive experience (culture)

(what do you know, expect, your
experience with pain, your conviction)
On a scale from 0-10, what do you expect?
 1/3: Sensory pain

• Location
• Intensity
• Duration
• Kind of pain
 1/3 Emotions related to pain

• Fear, anxiety or:strong & powerful

 Pain/panic fear

Non-effective adrenalin
contractions
 1/3: Cognitive pain

• Knowledge (culture) How to behave

• Experience with pain

(medicine/ hospital)

• Conviction
 What do you expect labour
pain will be?
Or: to witch number you are prepared to handle the pain

0 _______________________10

No pain / pain but tolerable/ unbearable

 To witch number are you
prepared to cope with pain?

0 _____________________10
 More
tolerance to
pain

Abandon
ego Hypnotic
ENDORPHINS state
and limits

Parasym
pathic
system
 Function of brain

Transmission of pain is subdued when:

1. you feel strong
2. convinced this is necessary
3. ending
4. not harmful
 Pain is alright!
Not harmful
BUT LEARN HOW TO SWIM
I am having strong contractions
You are dilating
The baby wants to come out
It is ending

THINK OF THE END RESULT

You cannot avoid the wave
Learn to surf on it
 Remember: after every contraction
a break without pain

Contraction 1 minute 4 min NO PAIN Next contraction

contractions acceptance

relaxed endorphins
Mislead your brain
You have a choice in how you
respond

You don’t have to be a victim of

your pain
 SO:
• Consider yourself very privileged you are
having your own baby
So don’t feel sorry for yourself (or your partner)
• You have to do it here and now
So don’t blame others or the circumstances (this country)
• You will become tired but that is no problem
So don’t find excuses (tired)
• Aim for a minimum of intervention
So don’t hope and wait for the doctor to "deliver" you

> keep/stay in control as much as possible

 These thoughts can help

• I am young
• I am strong
• I am healthy
• I am a superwoman
• I want this baby
• I can do this
• I need to open
• Think of your own positive line in
your own language
 Prepare for your journey
but once you are on the plane:
let go
It is all about mindset
AND End result

83
Disadvantage of extreme pain

Tension

Bad No hypnotic
experience state

No Contraction
progression stop
 Laughing gas in
Beval Centrum West
and Amstelland hospital
(A’veen)

Non medical with your own midwife

• Relivopan(gas and air)

• (N2O)
• Only for the lady!
Pain relief with medicine

From 1st to 2nd line

From your own midwife to
obstetrician or
midwife hospital
 Medicinal pain relief
in hospital

1. Injection in leg (Pethidine)

2. Drip in arm (Remifantanil)

3. Drip in spine (Epidural)

Pethidine injections
 1.Injection in leg

Pethidine injections: often a combination of

painkiller and sleeping medication
• (Not in every hospital)
• Reduces anxiety/ tension / some of the pain
• Works within 30 min for 4 hours
• Side effects (nauseous/not aware of
situation/hallucinations/breathing problems
baby many hours after injection, more
problems with breastfeeding)
• This is used when you are still in the
beginning, and already very tired.
 2.Morphine pump
(Remifantanil or PCA
PCA pomp: Patient controlled analgesic
Advantages
Works fast, efficient
Disadvantages
Attached to 2 drips, monitor and Oxygen meter
Every 15 min check oxygen level in blood mother
Very limited mobility
Most likely not possible to use birthing chair/ birth pool
Possible breathing problems mother and baby.
At 8-9 cm sometimes you used the max dose already
(Not the first choice of VU/ AMC)
 3.Epidural anesthesia

Injection of drugs
through a catheter
placed into the
epidural space.
Blocking the
transmission of pain
signals through
nerves in or near
spinal cord.
Works in 95% cases
very efficient
3.Epidural anaesthesia
(22%)

Fever 10-15 %
 Advantages epidural

• Gives peace of mind in pregnancy

• Pain relief from waist downwards in
the 1st stage
• Dosage of the drug can be controlled
• You remain alert
• More energy for pushing
• Most effective pain relief drug
• Available in all hospitals (in some hospitals not 24/7)
 Disadvantages epidural
• You sometimes have to wait after full dilation to feel
pushing contractions
• It slows down your labour
• Loss of muscle power so therefore:
• Less effective pushing contractions
• Not mobile, no vertical birth
• Drop of blood pressure, so drip in arm
• Attached heart monitor for baby and catheter
• 5% ineffective, or works only in one half
• Small % headache/ backache
• Sudden rise of temperature (10-25%)
mother>baby>incubator, antibiotics, separated
from mother> more difficulty with breastfeeding
and bonding
• Possible until 7 cm dilation/ not in every hospital
 a
Breathing and massage
exercises in different
stages of labour
You will receive a separate
handout with summary of
massage exercises
Open pelvic floor, knees
unlocked
 Contraction dance
partner behind women
Unlocked knees/nice music
or left hip to left hip

• Tell yourself:
• Relax, relax, relax
• Open up
• I want the baby to
come out
• Let go
• In your own
language!!
 Laptop position
great way to produce
oxytocin
Is from Greek word
OKYTOKOS= “fast birth”
 Relaxing massage

Palm tree
Fingers keep touching the back ,
fluent movement, include upper leg
Do it SLOW and with LOVE

Give as much pressure as she needs

at that moment
So:ask her!

Lady: deep breathing

Massage number eight
Pain-relieving pressure:
Tailbone stretch

Partner: give pressure

with one hand on
tailbone during strong
contraction, in case of
backpain
Lady: interval breathing
if slow breathing does
not work any more
Feel difference on a birthing ball
make your self as comfortable as
possible
 Pain relieving
pressure 2 hands
(the hands can also be a bit lower than shown on the picture)
 Shake the apple tree
in between contractions to release
tension

Go for the low

hanging
fruit….
 Massage with
2 tennis balls in sock
Put tennis balls in bag to hospital

Partner: Massage with two

hands symmetrical, lower back
Lady: relax knees, breathing
 Pain-relieving
acupressure with thumbs
(don’t practise in pregnancy,
it stimulates the contractions)
 Coping with pain:
misleading the brain

• Acupuncture points to relief

pain
 Most important task
partner

• Logistics (tel numbers, transport,

bag, coins for wheelchair)
• TO BE THERE!!!!
• To be CALM and supporting
• Help her with breathing
• Back to calm breathing in break
Childbirth Preparation
Course ACCESS
Lesson 3
 T.E.N.S.

Transcutaneous Electrical Nerve Stimulation

The light electrical pulses

distract you from labour pains.
Stimulates endorphins

www.geboortetens.nl
Check your insurance company
Sterile water injections
(not often used any more)

Blocks back pain

for two hours
Understanding the
function of pain

• Trust your primal brain/

your hormones, they will
do what they need to do
• It all has a reason
• Endorphins are also going
to the baby
 You don’t have to think how to
give birth. Just keep breathing.
Your body knows what to do.
The pain blocks the big
brain
You cannot/should not
think any more
 It all has a reason

Contraction
Pain
Stress
Catecholamine

oxytocin

More
tolerance Endorphins
for pain causing prolactin
hypnotic
state
 After every contraction a break,
after every break another contraction

Contraction
Pain
Stress
Catecholamine

oxytocin

More
tolerance Endorphine
for pain causing prolactin
hypnotic e
state
 The importance of the
break

• Stress free
• Deep calm
• Relaxed
• Activation of parasympathic nervous
system/hypnotic state
• Prepares for another rush of
catecholamine
 After endorphins you need to wake
up again by a contraction
otherwise labour would stop

endorphins contractions
Every intervention causes a cascade of other
interventions

oxytocin

prolactin

Protecting and
preparing the
baby
What are your biggest
friends
during birth
The contractions
Without contractions no
progression
Induction
 Induction: why?
To initiate contractions

When? (15%)

• Between 41-42 weeks pregnancy

• After > 72 hours membrane
rupture(3%)
• Meconium stained water
• High blood pressure
• Baby too small/ too big
 How to induce
Membrane stripping (sweep)

When:>41 weeks
Only when cervix is ripe
Why: To initiate contractions
How to induce labour?
Natural way
How to induce labour?
(doctor in charge)
 How to induce labour?
(Doctor in charge)

• Take a pill to make contractions

• To “propare the cervix” with balloon(foley)
• It can take a few days
 Chemical induction
• Drip chemical oxytocin
• Contractions more painful

• Don’t be tempted to be induced (41.5 wk)

(50% more chance vacuum, and need for
pain relief)
Chemical oxytocin versus natural oxytocin
Oxytocin injection after a normal birth

• Augmentation(stimulation) if no
progression (19,6%)
 If birth needs help
Instrumental delivery
Vacuum
C section
Vacuum (9,3 %)
=suction cup
 Caesarean- section
primary (planned) and secondary
(15-17%)
“ baby friendly” or “gentle”
C section
 After C section

• Paediatrician
• Partner with baby
• Recovery room
• Few days in hospital

• Call midwife when home Skin to skin

Eye to eye
 Apgar test (Virginia Apgar)
after 1, 5 and 10 minutes
1.Appearance (colour) 2 points
2.Pulse 2
3.Grimace (reflex) 2
4.Activity (muscle tone) 2
5.Respiration 2
10
Note: A:5/9 , A:10/10
Interactive discussions
and sharing ideas
Ladies talk with ladies
Men talk with men
 Sex during and after
pregnancy

www.zanzu.nl
Sex before the birth
Sex after birth

Please visit pelvic floor specialist

if not happy after two month
Childbirth Preparation
Course ACCESS
Lesson 4
 Stages of Birth
First: Dilation:
Passive stage: 7-8 hours
Active stage: 16 hours

Second: Pushing stage (when 10 cm dilation)

(10 min-2 hours)

Third: Afterbirth: birth of placenta

(10 min-1 hour)
 2nd stage
Pushing contractions
(when you reached 10 cm dilation)

Baby moves down the birth canal from the

cervix to the vaginal opening
(YouTube: animation birth)

First baby: 20min- 2 hours

2nd, 3rd baby: few pushes-60 min
Contractions will change
 How do you recognise?

• Urge to push several times on every

contraction (bearing down reflex)
• Transition/different mood (wake up)
• Really hard work, that’s why it is called
“labour”

• Midwife or doctor confirms with an internal

investigation: full dilation (10 cm)
• Choose your position
Animation labor and vaginal birth
https://www.youtube.com/results?search_query=labour+and+birth+animation

(Be aware that an episiotomy is not a standard procedure in the Netherlands and
that we give different instructions when to call the midwife and go to hospital)
Rotation and positioning of
head and shoulders in the
birth canal
Different kind of breathing in
different stages of birth
 Pushing contractions
• Push three to four
times on every
contraction 1 2 3
• Relax after each
contraction
Relax
• It takes ± one-two
hours
• Depends on position,
intensity of the
contractions and more
 To prevent headache when
pushing:
• Mouth a little open
• Eyes open
• Grunt/exhale little bit if necessary
• Realise/ visualise in which direction
you have to push
• Relax muscles after each contraction
• Breathe deep in and out
Panting: very superficial
fast chest breathing

HOW: If midriff moves up and down

Abdominal muscles cannot strain
So: more difficult to push
Head back and tongue out of mouth
(Exhausted dog)
(or like you steam up a mirror)
 Panting: when?
• You feel the urge to push
but you are not fully
dilated: lying on one side
helps
• Only push a little bit at the
peak of each contraction

• Pant (in Dutch:

hijgen or zuchten)
• Or very fast interval
breathing
• REMEMBER: Dog breathing
 Panting: When?

The baby is nearly born/crowning

You should not push too hard
To prevent tearing

This breathing is very superficial

chest breathing
Midriff moves up and down
Tongue out of mouth (dog after
running or steaming up a mirror)

You will be instructed by midwife

 What’s wrong with this
picture?

Imagine trying to restrict Imagine trying to restrict

an elephant to give birth a woman to give birth
on her back…. on her back….
It would probably require It would probably require
drugs and drugs and
might lead to surgery might lead to surgery
Birthing positions
start pushing
Birthing positions
Birthing pool
 Tips if you push in bed
• Lift legs up as much as you
can (with help from partner/midwife)
• Partner should support neck
• Inhale but
NOT TOO DEEP otherwise
you block yourself
• Push only from waist
downwards
• Open eyes and mouth
and… pelvis!!
• See next slide
Vertical birth

155
Shape of head after birth
 Stages of Birth
First: Dilation:
Passive stage: 7-8 hours
Active stage: 16 hours

Second: Pushing stage

(10 min-1.5 hours)

Third: Afterbirth: birth of placenta

(10 min-1 hour)
 The birth of the placenta

• Baby on Mum’s tummy

• Father cuts the cord (only if you want)
• You need to push once more
• Birth of placenta between 10 min-one hour
• Sometimes injection to prevent blood loss
Film about waterbirth
Childbirth Preparation
Course ACCESS
Lesson 5
 Postnatal Reunion
Who want to host?

When: on a Saturday or Sunday

at least 6 weeks after the last due date

Time: 12.00-14.00 (Monday group)

Or 14.00-16.00 (Tuesday group)
 Lesson 5

• The GOLDEN hour after birth: bonding

• Maternity care, why and how
• Information about breastfeeding (very limited)
• The first week: how to survive?
• Dutch habits and customs
• What to do:Post natal depression
• Rehearsal, interactive timeline puzzle

• Confirm date and location postnatal reunion

 Straight after the birth

• Shaking
• Bleeding
• Euphoric state: LOVE hormone
• Oxytocin sky high (not always)
• Baby will be with mother skin to
skin for ONE hour
• This is important to release stress
mother and baby
• This is called the “GOLDEN “hour!
 First few days

• Colostrums: very nutritious

• After birth: latch on baby <2 hours
• The more you feed, the more milk
• If baby does not drink >1 day:
express milk, give by spoon or cup
• Do not give sugar water or water
• Light and heavy babies: extra formula
• Weight of baby will be checked
• Do NOT give up within first two weeks
 Your first week

• 24/7, rollercoaster
• Overwhelming
• Emotionally instable
• Physical inability (including haemorrhoids)
• Baby blues
• Lack of sleep
• Don’t buy too many very small size baby clothes!
• Positive: You are very much in love with baby……

THIS IS ALL NORMAL !

 Kraamzorg

1. Minimum 24 hrs
(in 8 days is 3 hours per day)
2. Normal is 49 hrs
(in 8 days is 6 hours per day)
(recommended)
Home delivery 54 hrs

Own risk is €4,80 per hour

Some insurances cover this
 Role of kraamzorg

• Observes with a professional eye

• Advises, helps, cleans, washes
• Listens, reports to midwife
• Sometimes more nurses in one week
• (Tip: have some cash money for shopping)

• Nurse has to be nice! Otherwise ask

for other nurse.
• 4th day of childbed re-indication if
you need more hours of care
 Role of midwife
she will visit you every other day
(or call you)

• Medical view
• Questions from maternity nurse
• Removes stitches/staples
• Refers to paediatrician/
gynaecologist
• Talk about delivery issues
 Role of partner

• Help ladies to recover

• Support her while feeding
• Enjoy baby, make contact with
baby
• Ladies: You need rest!
• Don’t act tough
• Sleep while you can
Breastfeeding is a
challenge
Not always so easy

But: Don’t give up

within the first two weeks
 Please follow
a breastfeeding class
You cannot absorb all the new information straight after birth

•How partner can support

•How you can influence the amount of

breast milk you produce

•In which position you can best feed

without pain (breastfeeding not nipple feeding)
Baby blues
Is very normal on day four(4) after childbirth. Very emotional, sometimes a bit
down, crying etc. Due to massive hormonal changes in your body.
This is very normal and NOT a postnatal depression.
 Rain out of pink cloud

• 10-17 % women
Post partum depression
• 8-0% of fathers have it

• 20,000 per year

• 2-3 months after delivery

• 1/3 already had symptoms

in pregnancy
 What kind of women
You have 4x more chance
for
Post natal depression

• IF:

• Depression before
• Depression in family
Has a negative effect on
• Introvert bonding with baby and
• Non- supportive partner relationship with partner
• Uncertain
• Wants to be perfect…
 Symptoms
Post partum depression
• Insomnia/ sleep
disorder • Feelings of guilt
• Emotional • Hopeless
instability/ tearful • No feelings for
• Over caring baby
• Feelings of failure
• Sad
• Some of these
• Don’t want to do feelings can be
anything normal in the 1st
week(s), but not
after 2 months
 What to do when P.P.D.

• TALK, TALK (Taboo, shame, isolation)

• Supportive partner
• Early diagnosis (go to family doctor)
• Medicine for depression
• Hormones
• Vitamins B 6 en multivitamin
• Acupuncture
• Discussion group/internet
• http://www.balanceyou.net/postnatale-depressie-in-engels/
 If not happy after birth:
MAMAKITS
• Without referral of family doctor:
Intake per mail or telephone:
• mamakits@prezens.nl or
• preventie@prezens.nl
• 088-7885055
• Or:
https://psychezwangerschap.nl/en/
 First week of baby

• Register your baby within 3 working

days, but as soon al possible
• Midwife and maternity nurse
• First 24 hours/ vitamin K
• Rooming- in/co-sleeping
• What goes in must come out / scales
• Baby boy testis/ baby girl blood
• Navel
• Heel shot and hearing test
The Growth Guide ask for English version

1. Planning for parenthood

2. Pregnancy
3. Breastfeeding
4. Postnatal period

jgzgroeigids@ggd.amsterdam.nl
 Dutch habits

Birth KRUIKEN
announcement Hot water bottle
Decoration
 Last but not least

Thanks to ACCESS, look for more info

www.access-nl.org
 Good Luck
Relax and enjoy a
fantastic birth experience

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