Healthy pregnancy
When you are pregnant you have to pay attention to your health even more than usual. Your health affects the health of your unborn child. In addition, your own body is undergoing some changes as well. This is part of being pregnant, but can also raise questions. To make a good and healthy contribution to the development and growth of your child, we have provided some tips.
Weight gain
To gain some weight during your pregnancy is important. As your baby grows, so does your weight. In addition, your body is also building up some reserves.
The amount of weight you gain during your pregnancy depends on your Body Mass Index (BMI). If your BMI is low, your body will need more reserves compared to other bodies with a higher BMI.
- When you are underweight (BMI less than 19), you may want to gain 12 to 18 kilograms.
- For average weight (BMI between 19 and 25), it is normal to gain 11 to 16 kilograms.
- When you are overweight (BMI between 25 and 30), 7 to 11 kilograms are sufficient.
- When your BMI exceeds 30, it is important to only gain 5 to 9 kilograms.
Nutrition
During pregnancy it is important to eat fresh, healthy and varied food. To eat safely is extra important. You do not require to “eat for two”, but you do need certain types of vitamins more and there are some products that you may want to refrain from.
During pregnancy there are two diseases that you can infect the baby with, toxoplasmosis and listeria. You can easily prevent this with the proper nutritional advice. In addition to a healthy diet, it is important to take into account the use of foods and vitamins.
“Het voedingscentrum” has developed a nice app (in Dutch) to help you in your diet: ZwangerHap. Also, the RIVM provides some additional information.
Toxoplasmosis is a disease caused by a parasite. A toxoplasmosis infection can develop when eating or preparing raw meat or via cat feces. This may cause a miscarriage or a birth defect.
To protect yourself against toxoplasmosis, do not change the cat’s litter box yourself, only work in the garden with gloves on, and wash fresh vegetables thoroughly. In addition, you should not eat raw meat during pregnancy.
Listeria is a disease caused by bacteria. These are found in soft cheeses that are made from raw milk (“au lait cru”). It can also grow in products that are kept in the refrigerator long term, such as vacuum-packed fish, prepared raw vegetables or meat. So do not leave your products in the fridge for too long or rather buy them fresh.
Organ meat (including liver) contains a lot of vitamin A. Too much vitamin A consumption during pregnancy can be harmful to the growing baby. Therefore, do not eat liver and do not consume liverwurst or liver pâté more than once daily. Vitamin A is also added to many multivitamins but they may not be suitable for pregnant women. If you do take vitamins, please ensure that they are suitable for pregnant women.
If you normally tend to have more than one cup of coffee per day, then try to limit this to just one. Caffeine affects your baby, who will stay awake and active. The same goes for large quantities of tea or coke. Switching to decaf options is a good alternative.
Start taking folic acid in time. Take it from 4 weeks before the pregnancy up to and including 8 weeks after conception (this is the 10th week of pregnancy). Dosage: 0.4 or 0.5 milligrams.
Women with an increased risk of having a child with a spina bifida are advised a higher dose of 5 milligrams of folic acid. A prescription is required for these tablets, which can be provided by your GP.
During pregnancy, an additional 10 micrograms of vitamin D daily is recommended to help the baby building strong bones. Vitamin D ensures that calcium is properly absorbed from the diet. Adults produce enough vitamin D in their skin if they regularly go outside. For pregnant women with dark skin color or who are veiled, 20 micrograms of vitamin D is recommended. Vitamin D is available without a prescription from pharmacies or drugstores.
Cytomegalovirus (CMV) is a virus found all over the world. A CMV infection usually does not result in any complaints and may pass by almost unnoticed. CMV can be transmitted from person to person through saliva, urine, blood and sexual contact, among other things. The virus can be transmitted through cuddling or when changing diapers (among others). For the baby, this may cause birth defects. You can often prevent infection by washing your hands properly. If you wash your hands thoroughly with soap and water after contact with urine (changing the diaper) or saliva, the risk of contamination is reduced.
Do not use any medication without consulting your midwife, GP or pharmacy. Medicines can have a harmful effect on the development of your child. This also applies to medicines or homeopathic remedies that you buy and use yourself without a prescription.
Always tell your GP or pharmacy that you want to become pregnant, are pregnant or are breastfeeding. Your pregnancy (if any) can then be taken into account when providing medication.
The Lareb institute can provide you with more information on this topic.
Paracetamol
Paracetamol is the only painkiller you can safely use during pregnancy. The maximum dose is 6 tablets of 500 mg per 24 hours. When you have a fever (temperature of 38.5° C or higher) it is recommended to take paracetamol. Paracetamol causes your temperature to drop. Fever is not healthy for the growing baby.
Stimulants
Your unborn child completely depends on you. Through the placenta your child gets everything it needs to grow and develop. This also means, however, that other substances will reach your child that are less useful or even harmful. These include stimulants that are consumed by the mother.
Smoking during pregnancy carries many risks. When you are smoking yourself, or even when you frequently sit with other people who are smoking (through secondhand smoke), this can have a negative effect on the development of your baby. Cigarettes contain harmful substances that cause a reduced blood flow in the placenta, and this results in less oxygen reaching your unborn baby. This makes it difficult for the baby to grow and increases the risk of complications surrounding the birth.
It is recommended to quit smoking and avoid smoky areas if you already want to get pregnant. It often turns out to be difficult to quit smoking. You can contact us for help, support and advice.
Some helpful links to quit smoking
If you consume alcohol during pregnancy, your baby joins you. The alcohol will distribute itself over your body fluids and will also reach your child via the placenta. This means that the concentration of alcohol in your own blood is just as high as in the blood of your child. Your child’s liver is too immature and cannot process the alcohol itself.
Alcohol is harmful to your unborn child because it affects the cell development. During pregnancy, your child grows every day. As a result, alcohol has a negative effect on the development of the organs and brains of your child. This can cause your child to become disabled. Alcohol consumption may also lead to growth retardation.
The harm your child can incur depends on the amount of alcohol you drink. Alcohol is dangerous for your child throughout pregnancy, even if the placenta is not fully developed or if you do not yet know you are pregnant. It is therefore recommended not to use alcohol during pregnancy and even in the period before when you are trying to become pregnant.
Taking drugs whilst pregnant can lead to serious complications. It is therefore very important to be honest with us about this. Your child may still be healthy, but the risk of abnormalities has increased. This risk increases as you use more and more drugs.
You often only know after a few weeks that you are pregnant. But especially in the first weeks of your pregnancy, your child is very vulnerable. Everything that goes wrong during this time often has serious consequences for your child. It may lead to miscarriage, but may also lead to impaired development of the organs.
So if you continue to use drugs, you can harm your child at an early stage. For the expectant father, it is even recommended to stop using drugs at least three months before conception.
Rhesus factor
The Rhesus factor in your blood is a blood group or blood type. Blood types are proteins located on the outside of the red blood cells. There are more than 200 types of blood types. The most famous ones are the “normal” A, B, AB or O, as per the ABO blood group system. It is important to know your blood type if, for example, you need a blood transfusion after childbirth.
The rhesus factor is a different kind of blood type (using the Rh blood type system) and there are two varieties of this: Rhesus D and Rhesus c. Some women do have this blood type, others don’t. During your first appointment, some blood was drawn and this was tested to determine which blood type you have – ABO, Rhesus D, Rhesus c – and whether you have any antibodies.
The RIVM also provides some more information.
You will receive your blood results at the second check-up. If you are a D-negative individual, and it turns out that your baby is a D-positive individual, you can develop antibodies against your child’s blood type during pregnancy. Therefore, we will conduct an additional blood test in week 27, which will answer two questions:
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Did you develop antibodies?
The lab will check again whether you have made antibodies against blood types. Less than 1% of all Rhesus D negative women in the Netherlands make antibodies against their baby’s blood type. If the laboratory finds such antibodies, further analysis is required. Your midwife will tell you more about this.
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What is your baby’s blood type?
The lab will also determine your baby’s Rh(D) blood type. Your blood actually contains small quantities of your baby’s DNA, which is used to determine this. Your midwife will inform you what blood type your baby has. There are two options:
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- Your baby is a D-negative individual. This means both you and your baby have the same blood types; you cannot make any antibodies against your baby’s blood type.
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- Your baby is D-positive. You are Rhesus D negative and your child is Rhesus D positive. There is a chance that you will make antibodies against your child’s blood. To prevent this, you will receive an injection with anti-Rhesus D antibodies in week 30 of your pregnancy. This injection significantly reduces the chances of you forming antibodies that can make your baby sick. Your baby will not notice this injection and will not be at any risk. After the delivery, you will receive another injection. In theory there is no blood contact between mother and child. The blood streams of mother and child are separated by the placenta. Blood contact can only occur during childbirth, or when you have an accident, e.g. a fall on your stomach or a car accident. In such situations, you should always contact us. It is important to know that, once you have produced antibodies, these will remain in your blood and can enter the bloodstream of the (unborn) child via the placenta in the next pregnancy. This may result in problems when you are expecting a Rh(D) positive child. These antibodies in the mother’s blood break down the red blood cells of the baby causing anemia in your child.
Your blood results come back during your second appointment. If you are a Rhesus c negative individual, there is a small chance that you will make antibodies against your child’s blood type during pregnancy. Therefore additional blood tests are needed during pregnancy.
The Rhesus c factor is negative in 18% of all pregnant women. When the Rhesus c is negative, the outside of the blood cell is not covered with proteins. When it is positive, proteins can be seen on the outside.
Antibodies
A pregnant woman with a negative blood type can have a baby with a positive blood type. When there is blood contact between the both, the mother may start to produce antibodies against the blood of the child. These antibodies can reach and break down the blood of the child via the umbilical cord. Your child could then get anemia. Sometimes this happens before birth and sometimes only afterwards.
Rare
To check whether your body is producing antibodies, a blood sample will be taken from you in week 27 of your pregnancy. If you do not produce antibodies, no further checks need to be carried out. If the lab does find antibodies, further investigation is needed. Less than 1% of all Rhesus c negative women in the Netherlands make antibodies against their baby’s blood type.
You will not suffer from antibodies against other blood types, but once you have made such antibodies, you will not lose them. These antibodies may play a part in subsequent pregnancies.
No injection
Pregnant women with a Rhesus D negative blood type receive an injection to prevent them from making antibodies against their child’s blood. There is no such injection for pregnant women with blood group Rhesus c negative. That is why we want to check carefully whether you make such antibodies.
Work
When you are pregnant, you have to take care of a number of things at work. For example, you are entitled to maternity leave. In addition, it may be that you can no longer carry out your work in the way you are used to.
Your employer will ask for a declaration of pregnancy (“zwangerschapsverklaring”) during the pregnancy. Your due date is stated here. We can provide this declaration after the term ultrasound. Legally, you are obliged to report to your employer that you are pregnant no later than 3 months before the delivery. This gives your employer time to apply for benefits and find a replacement.
As a female employee you are entitled to pregnancy and maternity leave. This leave consists of a total of 16 weeks. These are 4 to 6 weeks before delivery and 10 to 12 weeks after delivery. You can choose when you want to go on leave before the birth. This must be at least 4 weeks prior to the delivery. We recommend that you take leave 6 weeks prior to the delivery. In practice we see that the last part can be heavy and cause more complaints. Of course we would like to see you taking some rest, so you are well prepared for delivery. The maternity leave starts on the day after the delivery. So if you give birth after the due date, you may have a few extra days off.
Sometimes work has to be ceased earlier due to illness, physical complaints or other medical reasons. Your official leave will then start 6 weeks before birth.
Other Tips
Your body is undergoing a lot of change during pregnancy. You will notice that you can no longer do everything as you are used to. Some things will feel different, such as exercising or making love, but you can keep doing it. It is better to skip some other things, such as an X-ray.
The doptone (or Doppler fetal monitor) is a device that can register the baby’s heart rate and make it audible.
From approximately 11 weeks of pregnancy, it is possible to hear your child’s heart rate using a doptone, depending on your physique and the position of your uterus.
The angelsound is also a type of doptone. However, this is less strong, making it often more difficult to find the heart. We do not recommend the use of such doptones. If you do want to use one, it is important to do so responsibly (and not too often) and to contact us if you have any concerns.
Good dental care is very important, especially during pregnancy. The hormones can make you suffer from swollen and bleeding gums. This makes it more difficult to keep your teeth clean.
During pregnancy, the dentist may give you an anesthetic. This is perfectly fine as anesthesia is applied locally and no harmful effects on the baby have been shown.
It is better not to have any X-rays during your pregnancy. The radiation may be harmful to your baby’s development. If possible, please wait till after delivery before having x-rays.
Preferably, do not go to the sauna in the first three months of your pregnancy. In theory, heating the body could possibly cause a miscarriage. However, there is no scientific evidence for this. For this reason, we advise you to avoid a discomfort feeling and not to go to the sauna during this period.
If you are used to going to the sauna regularly, you can safely do this during your pregnancy. Try to avoid the really hot saunas. Your own body temperature rises in the sauna and that can be detrimental to the condition of the baby.
The same is also true of taking a hot bath. 38°C is a good temperature.
During your pregnancy, you may also become unwell during a sauna visit much easier. Therefore, do not go inside for more than 10 minutes and make sure you are not alone.
During pregnancy, the use of the infrared sauna is not recommended.
Be extra careful and don’t overdo it. Sunbathing can cause pigmentation on the face during pregnancy, i.e.t the so-called “pregnancy mask”. This is not dangerous, but it can take a long time for these spots to disappear after delivery. This also applies to the solarium.
You can have sex while you are pregnant. The need for intimacy differs per woman and often also depends on the length of pregnancy. In a normal pregnancy, there are no do’s and don’ts regarding sexuality. Intercourse cannot cause any harm to the unborn baby. Only when there is blood loss or broken membranes sex is not recommended.
During or after intercourse, the uterus may become hard (resulting in some abdominal pain), because it contracts during an orgasm. This is no cause for alarm.
You can discuss problems or questions regarding sexuality with the midwife. This also applies to previous negative experiences with sexuality or difficulty with an internal examination. We can then take this into account and provide better support.
For more information on sexuality and pregnancy, also refer to our Intercourse section.
Physical exercise is good for you, even during pregnancy. Do not force anything though, drink plenty and listen to your own body carefully. Avoid risky and contact sports. As an expectant mother you are more prone to injuries because your joints are more flexible. Your baby is well protected and is very resilient.
Try to avoid any areas above 2150 meters altitude because the oxygen level is lower, which will affect both you and your unborn child. If you want to do winter sports, realize that you are less stable and have weaker joints. This makes you more prone to injury. Skiing is a sport with a high risk of falling. So please be careful.
As long as the pregnancy is proceeding normally, there is little objection to flying. At the end of the pregnancy, airlines no longer want to take pregnant women with them. This is because they want to reduce the risk of delivery on board. Inquire with the airline until when you are still “allowed”. Usually the limit is up to 34 weeks. We can provide you with a declaration of pregnancy when required.
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