I came to the Netherlands in 2010, to start a Master’s degree. To keep a long story short, fast forward four years and I now have this degree, I got married and got pregnant. And since I have a Dutch health insurance and have canceled the one I had back home, it was quite clear from the start, that I will receive prenatal care and give birth in the Netherlands. A pregnancy for a first time mom is a glorious and scary time on its own. Now, for a foreigner, a pregnancy in the Netherlands takes things to a whole new level!
“Pregnancy can take you by surprise. On many levels.”
Midwives: The Queens of Pregnancy
In Greece, where I come from, and in many other European countries as well as the USA, once you find out that you are pregnant, you call your gynecologist and he then becomes your obstetrician or refers you to one. Midwives have a secondary role, if any, and you will probably meet your first midwife at the hospital, when in labor. In other words, you are treated by a doctor as a patient that suffers from that serious virus called fetus.
The approach to pregnancy in the Netherlands is very different. And I have to admit that I was pleasantly surprised by this fact. It is considered a natural part of the human life cycle and is treated as such. Midwives are there to support and discretely monitor the mother-to-be, without unnecessary medical interventions. My personal experience with my midwives has been great so far. Both me and my partner feel comfortable to ask them questions and have never been rushed out of the office. On the contrary, I have read many stories about super-busy OBGYNs abroad, who will reply to all questions with “Because I say so” or “Because you are pregnant”.
Prenatal care: Non-invasive and bilingual
Since pregnancy in the Netherlands is considered a natural process, the medical interventions that take place during prenatal care are only the absolutely necessary ones. This means few ultrasounds, no weighing of the mother at every appointment, no unnecessary blood tests every time and definitely no potentially harmful ultrasounds just for the fun of looking at the baby. The growth of the fetus is checked by the midwife in much less invasive ways, such as listening to the baby’s heart and feeling the mom’s belly.
I was also very happy with the information I was given about prenatal testing, both in Dutch and English. The Dutch midwives that I have met so far all spoke great English and did not mind explaining everything to me in a language that I could actually understand. Since my husband is also not Dutch, this is an important advantage of receiving Dutch prenatal care. An added bonus of living in the Netherlands are the English birth courses, that are oh-so-helpful for expat parents-to-be. They are private and they do cost quite a bit, but some insurance policies will reimburse you and at least you have an option (which is not the case in many other European countries).
Kraamzorg: A new mother’s guardian angel
When I first heard about the concept of kraamzorg, I was not so excited about it. Coming from a country where the new parents have all the support and help they need from their families, the idea of having a stranger in our house the first week that our baby is born seemed rather bizarre. Then I realized two things: a) my family would not be around and b) family help also usually means family interventions and interference, when it comes to the couple’s parenting choices. (All coins have two sides and the bond of Mediterranean families is a great example of that.)
The best part about kraamzorg is that you have the right to ask for another lady, if you are not happy with the one you get. For example, if the kraamzorg lady is older and does not speak a word English, or if they disagree with your dietary choices, you can just ask for someone else to come and take care of you and your child. Kraamzorg includes checking the mother’s recovery, helping with breast feeding issues and even doing grocery shopping and light chores around the house! And your health insurance pays the biggest part of the kraamzorg expenses as well, how neat is that?!
Is everything really that perfect?
I know that this far I have described pregnancy in the Netherlands as perfect. This is probably because I have not given birth yet and I am comfortable in the fantasy world of the second trimester. There seem to be quite some women though, mostly expats, who are not happy with the way things are done here. What most women struggle with is the mentality of the Dutch society that pregnancy should be drug-free. Most Dutch women do not use epidurals or other forms of drug-related pain relief and are proud of what their body can achieve. Not all expats share this view though and some moms-to-be feel pressured to go natural, while they would just love an epidural or some laughing gas.
Additionally, the Netherlands have the highest rate of home births in Europe. While this 2013 study suggests that there is a low risk of complications when it comes to planned home births, maternal mortality rate in the Netherlands is higher than that in Greece, Italy, Finland, Esthonia, Slovakia and Poland, among others (2010 data). Whether this has something to do with delayed hospital transfers in the case of complications has not yet been proven.
Everyone’s perception of a perfect pregnancy and childbirth is different. I can only speak for myself and despite the fact that the Netherlands have a higher mother mortality rate than my homeland, if I gave birth in Greece, I would have to be lying on my back on a bed, surrounded by all sorts of medical monitors, with an IV in my arm and probably end up with a C section (because that’s what happens to 40% of women), even without a serious medical reason. Talking all that into account, I feel lucky that I can experience pregnancy in the Netherlands and I am curious to read your stories in the comments!
UPDATE aka “How I am now seen as a home birth advocate”
Do you see the number of comments under this post? Now that I am writing this update they are zero. The messages and comments that I have gotten on Facebook though have made it clear to me that this post gives the wrong impression. Maybe because people feel strongly about birth and are not patient enough to read until the last paragraph. People seem to believe that I am trying to promote home birth and that I am in some way or the other a secret member of the so called “midwife mafia”. So let me make some things clear: I am under the care of a midwife because so far -and I am grateful for that- I have an uncomplicated pregnancy. And -I will repeat that- I am happy with their care. This does not mean that I will choose a home birth though. In fact, since we do not have a car and our midwife told us that the transfer rate for home births to the hospital is 50% for the first child, I will opt for a hospital birth with my midwife. That does not mean that I feel this is the best option for everyone. It is just what I feel comfortable with.
I am not a medical professional. I am just a mother-to-be who has read tons of articles both for and against home birth. My opinion should not even matter. And this is why I shared my experience and not my opinion. And this is why nowhere in my article I mentioned a birth experience -but only the available options- and I am just focusing on prenatal care and the information I have about postnatal care. I surely hope though that when the time comes, I will have a positive birth story to share, even though the messages about traumatic birth experiences that were sent to me -both by Dutch and expat moms- managed to cause me quite some frustration.
I think the (notoriously
known) sentence ‘zwangerschap is geen ziekte’ acts as a red flag for
many (mainly foreign but also some Dutch) women (including me): of
course, it’s not a disease but it’s a medical condition (which – if not
treated as such – CAN have consequences of huge impact, that indeed are
potentially traumatising). This
sentence is often used to defend a medical policy that is more concerned with cost minimization than offering every-one the safest treatment…
This is a very interesting comment and something that me, as an expat, I was not aware of. I mean the negative connotation of the ‘zwangerschap is geen ziekte’ phrase for many people. In fact, when my midwife told me the phrase, I found it reassuring and refreshing, since I come from a country where all the money is made via scheduled, often unnecessary, C sections, inductions and prolonged hospital stays. I feel now that maybe Netherlands is at the other end of the scale.
I got a facebook comment that mentioned that women do not get regular gyno checkups here, like the pap test, so I shouldn’t support the Dutch medical system. Let’s not focus on the fact that I did not support the whole medical Dutch system (since I have no experience with it) and therefore these comments where a bit irrelevant. But let us focus on the fact that expats -especially new expats- do not have experience with the Dutch medical system and if you come from a country where the medical industry makes money from over-medication and unnecessary medical interventions, it is easier to get excited when you end up in a country where there is a more “natural” approach.
I have to admit that my inbox got many scary messages about how women are not receiving optimal medical care in the Netherlands, both when pregnant and not pregnant, and this did numb my enthusiasm. And it did get me worried. Mails about high infant mortality, babies who died because their mothers chose a home birth and other scary stuff were sent to me, with people blaming me that I actually promote this system. I have to say I feel baffled.
Allow me to agree with all those emails. I have much experience and sadly, most of this is negative. The Dutch medical system works for the insurance, not for the people. In most cases the “family doctor” will send you home with solely the advice of taking a paracetamol. Most cancer patients I knew died due to this, they lost precious time by being at home taking paracetamol!! As far as women’s health, it’s pretty scary and a downright disservice to them. When you reach 30 they send you a letter telling you that from now and on you are allowed to get one Pap smear a year. However, even if you do go and request it as part of a check up, the doctor can simply refuse it on the grounds of “why, do you feel pain somewhere?”. Ovarian cancer is free to roam here. Two years ago a 23 year old girl died from that. Why? Because “statistically” it was not likely for her to have that due to her young age. It’s criminal. The “natural” way you got so excited about is just a word to cover up “taking things too lightly”. With respect to prenatal and post natal care…women receive the least care possible!! One can see this only when they experience a different country. Personally, I’d chose a doctor over a midwife on any day because if something unusual happens the doctor increases my chances for either myself or my baby to survive. As for giving birth….anywhere but in NL!!!
To be honest though – I think that pregnancy and childbirth like breastfeeding are one of the things people have very strong opinions about and (some) people get very… strident with anyone who seems to be suggesting a different view. I can understand why to a certain extent but I think it makes it easy to forget that actually maternal (and infant) mortality rates are fortunately very low in the UK, Netherlands, Belgium, and Greece despite their different approaches. But actually when you are expecting a child for the first time it is more helpful to hear practical advice (based on negative and positive experiences) than only horror stories. Anyway, if someone finds their midwife completely ignoring their concerns or pushing a particular agenda – they can change to another one!!! If they want to be weighed on every appointment (or other prenatal tests) I think most midwives are open to that. And the nice thing about living in this part of Europe is that if you do feel very strongly against the way pregnancy/birth is treated it is possible to hop over the border into a country with a completely different approach. But I personally would much rather read truthful, positive experiences (like this article) than some of the vague references to DOOM that were posted by certain people over on the Facebook thread.
Thank you Phoebe for your comment. I agree with you, this is my experience as well. I also feel that women should support other women rather than terrify or attack them, so it was really refreshing to start reading positive comments as well 🙂
We just lost our incoming child a week back. He was already 15 week and doing great in the womb. But even though my wife was bleeding and pain for 3 days, midwife didn’t feel the necessity to send her to gynecologist, and hospital emergency didn’t accept us as our midwife didn’t refer. Eventually it ended with miscarrying a healthy fetus (how do I know he was healthy – they mentioned that after post inspection). There are standard medication and guideline for 2nd trimester pain and bleeding which doesn’t harm the baby, but seems like midwife was completely unaware of them. And big part is – even without knowing, they showed reluctance to save my child.
Keep in mind though that Dutch midwifes are essentially nurses in obstetrics. They are schooled and have close contact with hospitals and ob/gyns. From what I’ve read, American (I’m assuming you are from the US, so if I’m wrong, please do correct me) midwives are not nurses and often not medically schooled at all. So the comparison between the two is not valid, since they are in a completely different world from oneanother.
No, on my case they didnt have close contact. How do I know – our gynecologist later told us that miscarriage was due to an infection and there is a treatment for that. A timely action would had helped. And he asked us why we didnt came to hospital when bleeding started – and I told him why (midwife didnt think it was necessary). Later our midwife came to home to apologize about this situation – but what gone is gone from us.
So is this in the US or not?
No, it happened in NL. I wouldnt write about US situation in Dutch reviews.
In that case make a formal complaint. They have to work together with ob/gyns. If they don’t there’s plenty reason to switch and complain.
I am very sorry for your loss 🙁