Giving birth at HMC

HMC will continue to serve women who are giving birth, even during the coronavirus period. Normally, our information evenings are a vital tool to prepare expecting parents for the upcoming delivery. Unfortunately, we are currently unable to organise these information evenings due to social distancing rules. We will therefore summarise the most important aspects of giving birth at HMC for you below. You can also watch a video presenting you with a tour of our birthing rooms. 

If you have any questions, you are of course welcome to consult your midwife or doctor at any time during your pregnancy check-ups. Doing so will give you all the confidence that you need heading into labour. Any special rules applicable during the coronavirus crisis are shown in boldface.

Welcome!

Welcome to the HMC Westeinde Obstetrics ward! In our birthing rooms, medical staff representing various medical specialties closely collaborate to help patients. You may encounter:

• obstetricians and gynaecologists;
• perinatologists;
• doctors (who may or may not be in training to become medical specialists);
• midwives who supervise outpatient deliveries;
• nurse practitioners;
• maternity nurses who assist with outpatient deliveries;
• lactation experts;
• foundation doctors;
• student nurses;
• trainee midwives.

Our team

When you are giving birth, you will be assisted by a small group of health-care providers from the aforementioned categories. Not all of them will be with you at the same time. If you need them, however, they will be right here for you.

Low-risk deliveries are generally overseen by a midwife who works in association with a maternity nurse or a regular nurse. High-risk deliveries are overseen by a perinatologist or a gynaecologist, in association with a nurse. Our aim is to ensure that you have as few people around you as possible. You will only be referred to a different health-care provider if necessary.

How to arrive at the birthing rooms

• By car
  Will you get to the hospital by your own car? If so, park your car in the visitor car park near the HMC Westeinde rear entrance. You will find that this car park nearly always has parking spots available. In the event that no spots are available or that you are in a hurry, park your car at one of the emergency spots near the HMC Westeinde rear entrance: keep driving past the barrier on your left (in other words, do not enter the car park), turn a corner on your right, pass the barrier and park your car in the small car park. A security guard will open the barrier for you. Return your car to the regular car park as soon as the situation allows.
• Taxi
  If you arrive at the hospital by taxi, please get off at the HMC Westeinde front entrance.
• Public transport
  If you arrive at the hospital by public transport, please get off at the HMC Westeinde front entrance.

Closed door?

If the door is closed when you arrive, please press the black button. Such buttons can be found both at the entrance to the hospital and inside the building. We will then open the door for you.

Birthing rooms

Our birthing rooms can be found on the twelfth floor, to the side of the red lift lobby. The lift lobbies with their various colours are clearly signposted. Please note: due to the coronavirus crisis, you must take the lift in the green lift lobby to the twelfth floor in all cases for the time being, even if the expecting mother is already in labour. 

Entrance to the birthing rooms (red lift lobby)

Triage room and admission to the Obstetrics ward

If you called the unit for an emergency check-up while pregnant or after the delivery, you must come to the twelfth floor using the lift in the green lift lobby. You will find a triage room on the twelfth floor. A nurse and doctor will meet you in this room. This side of the building also has rooms where expecting mothers can be hospitalised either during their pregnancy or after giving birth.

Maternity ward

Normally, the maternity ward is on the third floor, to the side of the green lift lobby. Mothers stay here after they have given birth (for instance, following a Caesarean section). However, while the coronavirus restrictions are in place, the rooms on the third floor will be inaccessible and you will stay on the twelfth floor instead.

Would you like to see what the birthing rooms look like and how to access them once you arrive at the hospital? If so, be sure to watch the video or check out the following page (only in Dutch).

Prepare for the delivery

You can prepare for the delivery of your baby in various ways:

• Ask questions at your pregnancy check-ups.
• Talk to experienced mothers.
• Find information in books or on websites, we will list some reliable websites below.
• Take some antenatal classes. Many useful classes for expecting mothers as well as expecting fathers are taught in The Hague and surroundings, e.g. antenatal yoga, antenatal gymnastics, hypnobirthing and 'giving birth together'.

Birth plan

One way to prepare for the delivery is by drawing up a birth plan, in which you outline your wishes and expectations with regard to labour as well as giving birth. It is very useful to discuss this plan with your health-care provider in advance. In this way, your midwife or obstetrician will be familiar with your wishes and needs, while you will know what services are offered at HMC. Inspect or download the birth plan that we have drawn up for you.

When should you get in contact?

Your midwife may give you slightly different instructions on when to call her from your doctor or gynaecologist. As your own midwife, obstetrician or gynaecologist is the most familiar with your situation, trust their advice on when to call them. After all, every woman is different. Please call if you have any concerns!

In case of a low-risk pregnancy:

• Call your own midwife if you have any concerns.
• If you have been classified as a low-risk pregnancy and are in early labour, please call your own midwife. She will tell you when you should come to HMC Westeinde for the delivery and will notify the birthing room staff accordingly. In other words, you will not have to call the hospital yourself.

In case of a high-risk pregnancy:

• If you have been seen by a gynaecologist because you are expected to have a high-risk delivery, please call our emergency number (+31 88 979 2104) should you have any concerns or should it appear as though you may be in early labour. You can call this number 24/7. The phone will be answered by a nurse working at the birthing rooms. She will tell you when would be a good time to visit the hospital. Please note: you must have your patient ID card ready at hand when you make the phone call.
• Avoid showing up at the hospital without any warning. Always contact the hospital first! This way, we will know that you are coming and will be ready to receive you. It is particularly important that you warn us when you are on your way if the situation is urgent.

Labour and delivery

Onset of labour

Labour can start in many different ways. The process generally begins with contractions at various levels of intensity. The contractions will initially be irregular and hardly painful. They will gradually start to come faster, become stronger and last longer. When your contractions become regular, your cervix will dilate. At this moment, please contact us!

Alternatively, your labour may begin when your water breaks. In this event, you will involuntarily lose amniotic fluid, either in one large rush or in a small trickle. You will subsequently continue to lose amniotic fluid until the baby is born. Once your water has broken, your child may be born at once, but the delivery may also be several hours away. Should you lose any water, please check its colour. If you think that your water has broken, please call your own midwife in case of a low-risk pregnancy or call the emergency number (+31 88 979 2104) if you have a high-risk pregnancy and have been supervised by a gynaecologist.

Once you are in labour, you will be able to stay at the hospital. You may also be admitted to hospital for other medical reasons. While you are giving birth, you will have a birthing room to yourself.

One of our birthing rooms

Facilities

HMC Westeinde has fourteen birthing rooms. The rooms all look slightly different, but every room is equipped with the same equipment. Everything that is needed to look after mother and child is here. The bed on which you will give birth can be adjusted in several ways, meaning that you can give birth in just about any position. Every room comes with its own shower and toilet.

You can use several types of appliances in your room, without needing a reservation. For instance, we have the following appliances.

• Stability ball (yoga ball)
  During the cervical dilation process, you can sit on this ball, either next to the bed or in the shower. Alternatively, you can lean on it or hang over it.
• Water birth
  One of our rooms comes equipped with a built-in bathtub. Inflatable pools can also be installed in all of our birthing rooms, thus allowing for a water birth. We can install the pool either during the cervical dilation process or during the pushing stage. You will be charged €80 for the use of a bathtub or pool. For more information, please read the 'Water birth' brochure.
  Please note: not all women can give birth in a bathtub or pool. Some women need medical care that cannot be provided during a water birth. If you wish to give birth in a bathtub or pool, please discuss this matter with your health-care provider beforehand and be sure to include it in your birth plan.
• Birthing stool
  You can use a birthing stool while pushing.

 

Birthing room No 2 (the only room with a built-in bathtub)

Cardiac monitoring

If your baby's delivery is supervised by a gynaecologist, your baby's heart rate will be monitored constantly. We have a cardiotocograph (CTG) on the premises to assist with this process. Generally, the CTG will allow you enough room to change position if you wish. If you need more room to move around, HMC Westeinde also has a wireless CTG that can be used. Since this device is waterproof, you can take it into the shower or bathtub if necessary.

 
CTG showing the foetal heart rate

Pain relief during labour

If you need pain relief while giving birth, please do not hesitate to ask. Together, we will try and decide which type of analgesic is the most suited to your particular situation at that moment. When you discuss your upcoming delivery with your midwife or obstetrician, you will be provided with information on the various types of pain relief. You are allowed, but not obliged, to include your pain relief preferences in your birth plan. Below are a few of your pain relief options.

• Epidural analgesia
  This type of pain relief is generally very effective and will stop you from experiencing pain until the end of labour. It usually takes thirty to sixty minutes for an epidural analgesic to start working. You will be given a urinary catheter, as you will not be able to control your bladder. The analgesic will be administered by an anaesthetist on the third floor.
  If you are given an epidural analgesic, you will be at increased risk of a prolonged labour, a fever and a vacuum or forceps delivery. Some women experience a drop in blood pressure. For this reason, you will be administered fluid through a drip attached to a vein in your arm or hand. There is a slight risk of long-term complications, such as headache or backache.
• Pethidine injection
  This injection is administered to your leg or buttock. Pethidine is a type of morphine whose effects last between 2 and 4 hours . Following the administration of this medicine, you will still feel the contractions, but they will be less painful. The medicine will make you drowsy, thus allowing you to relax more in between contractions so you will have the energy needed to bear the next contraction. In addition, the medicine may cause nausea or dizziness and may also make you feel to be somewhat 'absent' during your baby's birth. Since it is vital that your baby is wide awake when it is born, we do not administer pethidine if we expect the baby to be born soon.
• Nitrous oxide (Entonox)
  This mix of gas and oxygen is particularly helpful when the cervix is nearly fully dilated. Entonox consists of 50% oxygen and 50% nitrous oxide. It is not the same as the nitrous oxide taken as a party drug, which is 100% nitrous oxide. The use of this gas during labour is therefore safe. You can administer the drug yourself by breathing it in through a mouthpiece as a contraction begins. While you will still feel the contractions, they will be more bearable. The use of nitrous oxide will not affect the course of the labour or your baby's health in any way. Once you stop inhaling nitrous oxide, the effect will wear off almost at once. However, you will wear a mouthpiece for 15 minutes afterwards to suck away the air that you exhale.
  

You can find more information on your options in the Pain relief during labour brochure.

The immediate aftermath of the delivery

As soon as your baby has been born, we will place the baby on your belly and either you or your partner will be able to cut the umbilical cord if you wish. We will also offer the baby its first meal at this time. If you wish to breastfeed your baby, we will help you position your baby in such a way that it can feed. We will help you assume a comfortable position. Should you plan on bottle-feeding your baby, you can do so while maintaining skin-on-skin contact with the baby. While you are at the hospital, we will provide you with infant formula, so there is no need to bring any of your own.

If you need any sutures, you will typically receive them immediately after the placenta has been expelled. The midwife or doctor will weigh your baby and check whether it is all right. Your baby will stay with you in the birthing room. You will receive assistance when you take a shower, or we will wash you in your bed, depending on your desires and your condition.

Additional medical assistance during labour

Many different medical situations can occur during labour and we are prepared for every single one of them. HMC Westeinde has medical specialists on duty 24/7, including a perinatologist, a gynaecologist, a paediatrician, an anaesthetist and a surgical team. The mother's or baby's condition sometimes requires a speedy end to the labour. HMC Westeinde has all the equipment and facilities necessary to hasten delivery. If yours is a high-risk delivery, responsibility will be transferred from your midwife to a gynaecologist.

Special procedures

Please find below a list of special procedures that may be performed during labour. We will only perform these procedures if they are a medical necessity.

• Stimulation with oxytocin
  If your contractions are inadequate or if your cervix is not sufficiently dilated, your contractions may be induced through intravenous oxytocin.
• Caesarean section
  In some cases, a doctor will decide that a Caesarean section is required in order to hasten the delivery. The Caesarean will be performed in an operating theatre on the third floor. You will be given an epidural, so you will be awake when your baby is born. In certain exceptional cases, a Caesarean will be performed while the expecting mother is under general anaesthesia. Your partner may attend the Caesarean if they wishes to do so. However, your partner will not be allowed to attend the section if either you or your partner may have been infected with the coronavirus.
  Have you and your gynaecologist scheduled a Caesarean? If so, consult the 'Family-friendly Caesarean section' brochure.
• Vacuum or forceps extraction
  If your doctor decides that the delivery must be hastened during the pushing stage, they may decide to perform a vacuum or forceps extraction. Generally, this procedure involves the use of a suction cup with a handle. The doctor will place a small suction cup on the baby's head to help guide it into the world. Typically, the doctor will also perform episiotomy, i.e. a surgical cut at the opening of the vagina.
• Placenta removal
  If part or all of the placenta is not expelled from the uterus, a placenta removal may be required. This procedure, which is performed in an operating theatre while the mother is under general anaesthesia, is called a 'manual placenta removal'.
• Total rupture
  In exceptional cases, the anal sphincter may tear during labour. If such a rupture happens, the best solution could be to have the tears sutured while the mother is under general anaesthesia. This procedure will be performed in an operating theatre by a gynaecologist.
• Special assistance for the baby
  Some newborns need additional assistance in breathing outside the womb. Every birthing room comes equipped with a special table where the newborn can receive this assistance. If your baby needs help, a paediatrician will be on hand quickly to offer assistance. A paediatrician will sometimes attend the delivery in order to provide immediate assistance; for instance, if the baby is born prematurely.

After the delivery

After the delivery, women spend two to three hours inside the birthing room on average. If everything goes according to plan, you will be able to go home after a few hours or to the maternity hotel, even if it is in the middle of the night. In some cases, either the mother or the baby will have to stay in the hospital a little longer. If so, you will be transferred to the maternity ward or to the paediatric ward. Where possible, we will try to keep the parents and their baby in the same room. Unfortunately, due to the coronavirus restrictions, partners are currently not allowed to stay at the maternity ward.

When you go home, we will give you the following documents:

• an exit ticket if you came to the hospital by car;
• papers that you can use to register the baby's birth with the registry office.

You must register your baby's birth with the municipal authorities within three working days after the birth. To do so, you can schedule an appointment online.

Postnatal care

Please contact your postnatal care service before leaving the hospital. A maternity nurse working for a postnatal care service will spend several hours a day at your home in the first week after your baby's birth. They will perform check-ups of both mother and child as well as provide you with assistance and recommendations in the first week post-partum.

Aftercare

In the first ten days post-partum, the midwife will carry out the medical supervision of mothers and newborns who reside at home. She will visit you at home several times during the first week post-partum and can be consulted by phone if you have any concerns, either about your own condition or about your baby's condition. Generally, she will come and see you the day after you have returned home. If you had a high-risk delivery at the hospital, a nurse will contact your midwife as soon as you are ready to leave the hospital.
At present, midwives have to minimise the number of times that they visit new mothers at home due to the coronavirus restrictions. Your baby will have its neonatal heel prick at home, as usual.

HMC Maternity Hotel

HMC Westeinde has established the HMC Maternity Hotel in the Ibis Hotel near the hospital. If you wish, you and your partner can choose to stay at the hotel with your baby rather than going home. A maternity nurse is on hand 24/7 at the maternity hotel. For more information, see the HMC Maternity Hotel website.

What should you bring to the hospital?

Items for the expecting mother

• A comfy shirt or camisole to wear during labour
• Underwear that does not fit too snugly (so you will be able to wear maternity pads)
• Comfy clothes for after the delivery
• Nightgown or pyjamas
• Additional pair of socks
• Toiletries (e.g. shower gel, toothbrush, toothpaste)
• Flipflops

Items for the baby

• Two sets of clothing for the baby (sizes 50 and 56): socks, romper suit, jumper and pants or onesie
• Two hats for the baby (one of which must be allowed to get a bit dirty)
• A coat and/or swaddle cloth for the baby
• The baby's own bottle, if you have chosen to bottle-feed the baby

Other items

• A one-euro coin for a wheelchair, if you might need one
• HMC patient ID card
• Camera or phone (to take photos)
  Please note that you are only allowed to record videos if the health-care providers involved have explicitly given their permission to do so.
• Wallet
• Phone/camera charger
• Maxi-Cosi/baby car seat

Optional items

• A hot water bottle or cherry pit heat pack
• Some snacks, e.g. fruit biscuits, muesli bars, banana
  (bread and bread toppings are available at the birthing rooms at all times)
• Lip balm
• Massage oil
• Robe
• Birth plan

What to leave at home

• Valuables, e.g. jewellery

Things that you will not need

• Nappies, formula, maternity pads, etc. We will provide all these things at the hospital.

More information (in Dutch)

HMC brochures

• Zwanger en bevallen bij de gynaecoloog [High-risk pregnancies]
• Pijnbestrijding tijdens de bevalling [Pain relief during labour]
• Bevallen in bad [Water birth]
• De ingeleide bevalling [Induced labour]
• Zwanger en bevallen na eerdere keizersnede [Getting pregnant and giving birth after a previous Caesarean]
• Gezinsvriendelijke keizersnede [Family-friendly Caesarean section]
• Geboorteplan [Birth plan]

Pain relief during labour

https://www.haaglandenmc.nl/specialismen/ziektebeeld/pijnbestrijding-bij-bevalling
KNOV (Royal Dutch Organisation of Midwives)
NVOG (Dutch Society of Obstetrics and Gynaecology)

Useful websites

• www.deverloskundige.nl
• https://www.cjgdenhaag.nl/
• https://allesoverzwanger.nl/
• https://www.degynaecoloog.nl/onderwerpen-per-thema/