Useful information.

Multiple births

One in every 100 pregnancies is a multiple birth pregnancy. Usually it is twins, sometimes triplets. The number of multiple births has increased considerably over the last few years. That is partly a result of the fact that women become mothers later on in life. The chance of double ovulation increases with age. Another explanation is the fertility treatments that are available. These also increase the likelihood of multiple births.

The probability of a preterm birth is greater than with a singleton pregnancy: between 55 and 60% of multiple births are premature. In singleton pregnancies this is 5.5-6%. A low birth weight also occurs more often: more than half of the multiple births have a birth weight of less than 2500 grams. In singleton births, this is 4-5%. 

Twin-to-twin transfusion syndrome

A special situation that may occur in a multiple birth pregnancy is the twin-to-twin transfusion syndrome. This occurs in twins who share the same placenta and where there are connections in the placenta between the blood vessels of both children. Those vessel connections allow blood to go from one child to the other. When the blood is pumped back again, it is in balance and there is no danger. But when the recipient child does not pump blood back or only a small amount, the other child (donor) will receive too little blood. This situation is dangerous for both the children. It is possible to treat this syndrome during the pregnancy.

Different care needs

A doubly worrying time follows a multiple birth. Often the two (or more) children need different treatment and care. Although hospitals try to avoid it, it may turn out that for the best possible care they have to be separated and even be sent to different hospitals. Sometimes one of them goes home sooner than the other. In all of these situations, parents can feel overwhelmed by all sorts of emotions and also have to make many complicated decisions. Who do you need to be with the most and when? Are you strong enough yet to go back and forth between different hospitals to be with your children as much as possible?

Extra tiring

Multiple birth parents regularly indicate that for them it is also more difficult to get attached to one or the other. For instance, your attention is focused on the weakest of the two. Or the child who is home already demands all your care and attention (also at night), which leads you to becoming exhausted. In any case, the arrival of premature twins or multiple babies means an extra tiring period. Even when the children are home, this requires extra energy and may lead to more sleep deprivation. Consult the doctors and nurses about what care and feeding you can and cannot handle at home; this can be taken into consideration. It is important to indicate that your personal circumstances have to be taken into consideration, especially if you were ill during the pregnancy or if you are a single parent with a smaller help network.

Carrying your baby

Babies need a lot of physical contact. Carrying your baby in a sling or ergonomic baby carrier is a practical and pleasant way to strengthen the bond between you and your baby. Carrying brings about more interaction between you and your baby and through that helps bonding; by being close you get to learn and understand your baby’s signals better.

  • Baby slings and carriers: There are many different sorts of baby wrap slings and baby carriers on the market. There are ones made of stretchy cloth and woven cloth. And there are soft, preformed ergonomic carriers for sale. There are also slings. These are shorter clothes which you put over one shoulder. Get good advice when you buy a baby wrap sling or a baby carrier. You can contact a carrier consultant for this. The department of neonatology has its own carrier consultants. They can give you advice on the various carriers and they can help you practise putting the carrier on and fastening it.
  • Stimulating secure bonding: Research shows that carrying your baby stimulates secure bonding. Babies who have physical contact with their parents for at least four hours a day are much quieter and cry less. This is because physical contact stimulates the production of oxytocin. This is also called the cuddle hormone or happiness hormone. Research shows that physical contact also turns out to be beneficial for the development of a child’s brain. Physical contact helps the construction of new connections between the brain cells and eases stress so that the baby’s brain can develop optimally. This also has a positive effect on your baby’s motor development. Because of the security that babies experience while being carried, the baby’s heart rate, breathing and temperature become more stable. In addition, as a result of being carried, the release of the growth hormone is higher, which in turn stimulates your baby’s growth. Having a lot of physical contact with your baby is also positive for your baby’s social emotional development.

    When your child is carried, he only has to make minimal effort to make clear that he is hungry. As soon as the baby makes sucking sounds or when he/she sucks his/her fist, you know your baby wants to drink. In this way you avoid your baby having to cry. Even if it is not always possible to discover what your baby needs, your baby feels that you are there for him. Your baby feels safe. Moreover, research also shows that carrying your child increases the length of time that you breastfeed and the frequency of feeding. That is because you react faster to your baby’s hunger signals.
  • Position during carrying: When carrying your baby, it is important that the baby is supported in his natural position as much as possible. Some baby carriers offer too little support for the back and neck or let the legs “dangle”, which can increase the risk of hip dysplasia (an abnormality of the hip joint). We mean a natural position when the baby is sitting up straight in the baby wrap sling or baby carrier, with the legs spread and the knees higher than his/her bottom. This is also called the frog position.
Vaccinations

Full-term babies, as well as premature babies receive vaccinations. These are the vaccinations offered to all Zambian children as per the national guidelines. There are important diseases that can be prevented by vaccinations.  The first vaccination given is the OPV (0) and BCG vaccine at 0-13 days after birth, however for premature babies BCG vaccine is deferred till discharge from the hospital. All other vaccinations starting at 6 weeks chronological age are given as per the vaccination schedule.

Around the age of 6 weeks receive OPV 1, RV 1, DPT/Hib 1, HepB 1 and PCV 1. Four weeks later, at 10 weeks of age OPV 2, DPT-HepB-Hib 2 and RV 2 are administered. After 4 weeks, at 14 weeks of age, OPV 2, DPT-HepB-Hib 3 and PCV 2 are given. Following this the next vaccination is at 9 months which includes Measles 1 and Rubella, PCV 3 and OPV 4(If OPV 0 was missed). At 18 months, Measles 2 and DPT are administered. 

Applying for a leave of absence

It can be hard when your baby is taken into the department of neonatology. In addition to the many emotions that it brings, some practical questions come up too. How do I arrange it with my work? Do the same rules for a leave of absence apply to both my partner and me? Will I get maternity leave? In most situations you can have regular consultations with a medical social worker. Practical matters like leave of absence will be discussed. If your baby is in hospital for a longer period and you and/or your partner have a job, then maybe you will have questions about the possibility of taking a leave of absence. Maybe you will wonder what the best way to discuss your situation with your employer is. Or you might wonder if you are entitled to a leave of absence when your baby is in hospital. It is important that your employer knows about your situation. Tell your employer by phone or in person that your baby is being treated in hospital and what the consequences are for your work. When your employer is aware of your situation, you can discuss the following possibilities for leave with him/her:

  • Calamity leave. 
  • Short leave of absence. 
  • Short-term care leave. 
  • Long-term care leave. 
  • Maternity/paternity leave.

It is also possible that you do not feel able to work because of your child’s situation. For instance, because of physical or mental complaints. If this is the case, you can call in ill. Tell your GP about it. Your employer can ask you to phone the occupational physician or you might automatically receive an invitation for a consultation with the occupational physician. If you want to get in touch with the occupational physician yourself, you can request that. The occupational physician will tell your employer about the consultation. The employer can ask for a medical declaration for your baby. You can ask your doctor yourself for this medical declaration. If, after all these steps, you still have questions or need mediation between you and the employer and/or company doctor, you can discuss this with the medical social work service. 

During your maternity leave you will receive maternity leave. How long your maternity leave will last and how much the benefit will be depends on the legislation and your own personal situation. Normally you are entitled to 16 weeks leave. You can find more information on this on the website of the Employee Insurance Agency. If you are employed, you can apply for maternity leave via the Work and Care Act (WAZO) if after birth your baby has to stay in hospital for longer than one week. You can download the form to apply for this benefit on the Employee Insurance Agency (UWV) website. You will need a declaration from the hospital to do so. A medical social worker can help you with this. Here you will find other criteria you need to meet in order to apply to receive this benefit. If you are self-employed, then you might be eligible for Self-Employed Regulations.

Insurance

Apart from registering the birth at the city council, you have to report your baby’s birth to your health insurance company, if you have it, also to your life insurance company. You can check with your health insurance company if you have extra insurance and have a right to incubator aftercare. Contact the medical staff for assistance with signing up for the National Health Insurance Management Authority scheme. 

Birth registration

The law states that births should be registered within one month following birth, but a registration is considered late only after 12 months. Parents can initiate birth registration at the health facility where the child was born (if the facility provides such services) or at the DNRPC office in their district. As a first step in the registration process, parent(s) or guardian(s) must present their National Registration Card. After the applicants have been identified, registration agents at health facilities complete the Notice of Birth, to which they attach a document issued by the maternity ward. Registration agents at health facilities complete the Notice of Birth; these are transferred regularly to the DNRPC office in the appropriate district. Based on the notification of birth from health facilities, the district registrar enters a new registration record into the birth registration book.

  • Who has to register the birth?
    • The father or duo-mother should register the birth. What if the father or duo-mother is not able to do so? Then the registration must be done by someone else who was present at the birth. What if there was no one else there? The registration can also be completed by: someone resident in the house where the baby was born. 
    •  Head of the institution (for example, the hospital).
  • What do you need? 
    • Your baby’s birth names
    • Date and time of birth; your own valid ID- National Registration Card 
    • Declaration of birth by the hospital or the midwife
    • If applicable, a copy of the certificate of legal recognition of an unborn baby (you received this copy at recognition)
    • Your marriage or partnership booklet, if you wish the municipality to register your baby in it
    • A proof of registration stating your marital status, if you live abroad.
Legal recognition and parental authority

The legal recognition of a baby usually means the following: 

  • A legal bond is formed between you and your baby (family legal relationship).
  • You have to look after your baby (care obligation) until he turns 18 years of age. 
  • You and your baby become each other’s lawful heirs. 
  • You choose (together with the partner) your baby’s surname at the moment of legal recognition. 
  • Your baby will probably get your nationality. This depends on your nationality and the law in that country. 

Parental authority for a child means the following:

  • Raising and looking after the child. 
  • Paying for upbringing and care. 
  • Official acts on behalf of the child. 
  • Liability for damages. 
  • Managing the child’s assets.  
Child Health Care

Child Health Care (CHC) is there to promote health and a safe growing up for all children in the Netherlands. This is also for premature, SGA and ill children. Together with the parents, the CHC will follow your child’s growth and development from the pregnancy till the age of 19. Your child will receive vaccinations according to the Dutch vaccination programme at the CHC, as well as screening, such as hearing and eye tests. During the consultations at the CHC, the development of gross and fine motor skills, mental development, speech, language and emotional development are all examined. How you are doing as a family is also discussed. The CHC has prevention as a starting point. This means that they aim to prevent problems from developing or help is given as early as possible to prevent things from getting worse. If needed, CHC can lead to care.

  • Joint follow-up outpatient clinic and Child Health Care: In some hospitals the CHC consultation hours are combined with those of the paediatrician. In this way you do not have to go to appointments as often and there is close cooperation between the CHC and the Paediatric department. If there is no such joint consultation hour in your case, then you can – in addition to the appointments at the hospital – just go to the Child Health Care appointments.

In complex and/or multiple developmental problems, the paediatrician will involve professionals with the right expertise.

Day Care

A frequently asked question is when can premature, SGA or ill children go to daycare. There is no general, simple answer to this question. Of course, it strongly depends on the medical history. Did your child have serious (lung) problems? Does he need special care or treatment now?

You can discuss this with the paediatrician; there are also things you can take into consideration yourself.

  • Risk of infection: being in contact with other children in day care also means being in contact with contagious illnesses. When your child goes to daycare, he will probably become ill more often. This can vary from a light cold to more serious problems, such as shortness of breath or feeding problems, hospitalization may even be necessary. It is impossible to predict how serious your child’s infections will be. Young children can be ill 10-12 times a year. Sometimes one infection period goes straight into the next. And as a parent you often join in.
  • Season: is your child going to go to daycare for the first time in the summer or rather in the winter? Winter is the season for the common cold and flu viruses so it is more likely that your child will become ill.
  • Many stimuli: it is often busier at daycare than at home. That means that there are many more stimuli. Premature, SGA and ill children often find it more difficult to process all the stimuli and new impressions. This may lead to restlessness, sleeping badly and crying when they are home again. How does your child respond to busy surroundings?
  • Age groups: Are the groups in your day care centre organized horizontally or vertically? Horizontally means that children of the same age are with each other, for instance, a baby or a toddler group. A vertical group looks more like a family situation, with children of different ages in one group. If your baby becomes restless quickly because of too much happening around him, a group of children with the same age is more suitable.

Do you have alternative possibilities? For instance, grandparents, nanny, for other people around you?

World Prematurity Day

Every year on 17 November, we raise awareness for the huge impact a premature birth has on parents and families: World Prematurity Day. 

Contact with other parents

Probably everybody around you is doing their best to imagine your situation, and to support you. But sometimes it can be nice to talk to others who have been through the same as you. For example, you could find understanding and recognition among parents whose child was also in hospital after the birth. 

Probably everybody around you is doing their best to imagine your situation, and to support you. But sometimes it can be nice to talk to others who have been through the same as you. For example, you could find understanding and recognition among parents whose child was also in hospital after the birth. 

In addition, you can get in touch with other parents via social media.

If you need any help processing your emotions, do not hesitate to consult the doctor or nurse.

Useful links

For many, the journey through a neonatal unit can be overwhelming and stressful. The unit staff are always here to support you and answer any questions you and your family may have.

The following list of charities can provide further support and information on various topics. Some of the charities also have parent groups and networks that can connect you with others who have gone through similar experiences to yourself. We have found that some families contact other support networks from early on, while others contact them later in their journey when things have settled. Others wait until they have gone home and are looking back on their experiences and find that they would like further support. Each family is different, and the support is there no matter where you are in your journey.

  • Bliss – Bliss is the leading UK charity for premature and sick babies. They support parents with both practical help and emotional support. They have published many informative leaflets, have dedicated face to face volunteers who visit the unit to provide support, as well as an email service to provide support for those who would prefer this type of support. They are also heavily involved in improving standards of practice and care of the premature and sick infant by working alongside healthcare professionals to provide training, support and research. Furthermore, the charity campaigns and lobbies for changes to policy, investment and standards of care in order to make a lasting difference to neonatal services right across the UK. Bliss aims to standardise the care received by a family no matter where in the country you and your baby are cared for.

    https://www.bliss.org.uk/
  • Mothers Union – The Mothers’ Union are an international community-based christian volunteer movement with a local branch based in Brighton. They work with families of all faiths and none and visit the unit regularly to provide a listening and supportive ear to parents, while providing delicious baked goods.
  • Amaze (Brighton support group) – Amaze are a charity that provide advice and support to families of children and young people with special educational needs in Brighton & Hove and Sussex. Advice Line: 01273 772289

    https://amazesussex.org.uk/
  • Contact – A charity for families with disabled children. They provide information, advice and support, as well as workshops for families. You can talk to an adviser through their helpline, access emotional support through their ‘listening Ear’ service or connect with online communities. They also campaign for policy change and research to tackle inequalities faced by families with disabled children. Helpline: 0808 808 3555 (Monday-Friday, 9:30am-5.00pm)

    Home
  • Group B Strep Support – This UK wide charity provides information and support to families affected by Group B Strep (GBS). They raise awareness and provide education to aid in preventing and spotting early warning signs. As well as campaigning for changes to policy and research into GBS. Their helpline is open to provide you with support and answers to your questions around GBS. Helpline: 0330 120 0796 (Monday-Friday, 9am – 5pm)

    Group B Strep Support
  • Twins Trust – Formally known as TAMBA [Twins and multiple Birth Association], this charity provides support and information to families of multiple births. Twinline is their support line for parents wishing to speak with other 27 multiple birth parents for support, reassurance or guidance. Twinline: 0800 138 0509 (Monday to Friday, 10.00am-1.00pm and again at 7.00pm-10.00pm)

    https://twinstrust.org/
  • NEC UK – A parent led organisation that offers support to families affected by the condition at any stage of their infants’ journey. They offer support groups via online platforms and through emails, where families can share their experiences and coping strategies. You can email them on info@necuk.org.uk or visit their website

    https://www.necuk.org.uk/
  • TOFS [Tracheo-Oesophageal Fistula Support] – A charity dedicated to improving lives for those born with OA/TOF/ VACTERL conditions. They do so by offering one-to-one support, a range of information and resources for families. They can be contact via telephone: 01159 613092 or via email: info@tofs.org.uk
  • NCT [National Childbirth Trust] – The NCT’s mission is to support parents through the first 1,000 days to have the best possible experience of pregnancy, birth and early parenthood. They have lots of advice and support on their website for new parents. Their helpline provides practical and emotional support with feeding your baby as well as general information. Please see their website for usual opening hours. Helpline: 0300 330 0700

    https://www.nct.org.uk/
  • Sands – Sands is the leading stillbirth and neonatal death charity in the UK. They provide support for anyone affected by the death of a baby for as long as they need it. They provide bereavement support via their helpline, online community and resources, and a mobile app. Helpline: 0808 164 3332

    https://www.sands.org.uk/

Sites on breastfeeding

  • The Dutch Association of Lactation Consultants
  • Nutrition Centre
  • La Leche League (LLL).
Back to work

The weeks fly by and before you know it you are expected back at work. Find more about after birth leave right (mother and partner) here:

https://www.parliament.gov.zm/sites/default/files/documents/acts/The%20Employment%20Code%20Act%20No.%203%20of%202019.pdf

Disclaimer

Welcome to the NeoCare app! We hope that this app will give you the information you are looking for. 

The information partly comes from the growth guide. The app includes a diary function and a calendar function, where you can record how your baby is doing and what appointments are planned. This diary is only accessible if you are logged in. The department nurse will give you the log-in details. You can then send your family and friends an invitation for the diary.

  • Aim of the app. To make important information centrally available with respect to hospitalization, treatment and care of your baby in the department. As a hospital we will send you important information via the app about your baby’s hospitalization, treatment and care in the Department of Neonatology. Before using the app, we would like to make some agreements with you.
  • Points of attention for patients and family: Nothing from this app may be copied or duplicated except for your own personal use without the written consent of the hospital where you are staying. The information in the app is drawn up with care. Should there be any mistakes or if it is incomplete, you cannot derive rights from it and we would like to hear from you. It is allowed to take pictures and videos for your own personal use and personal social media. However, it is explicitly not allowed to take pictures or videos without the consent of the people who are in it. We hope you enjoy using this app!

For readability in the NeoCare App, “he” is used when it is about the child. Of course, it can be the other sex too. In addition, the mother is sometimes addressed more often than the father in the text. Please understand that the information is meant for all types of carers and parents. When we write about parent(s) or the mother and father, also two fathers, two mothers, single parents, foster parents and other carers are meant.