Pregnancy in The Netherlands

 

This is part one in a series of three posts detailing my practical observations of giving birth in The Netherlands. This is not a post about my personal birthing experience…as in the OTT actual stuff that happened…for that you can read Knocked Up Abroad Again where I contrast my birthing experiences in Turkey and South Africa.

Let me say from the outset that this was my third baby. I gave birth naturally, in a hospital, attended by a kick-ass midwife. I cannot speak about c-sections, VBACS or birth with pain relief. This does not mean that I am biased towards natural birth. Every mother should be able to choose for herself and have that decision be honoured.

The information that follows is about Pregnancy in The Netherlands. You can also read about Birthing in The Netherlands and Postnatal Care in The Netherlands.

Ready? Here we go with Part 1…

Pregnancy in The Netherlands

 

The first trimester you’re on your own.

Congratulations you’re expecting! You’re excited to get the ball rolling, go for your first ultrasound, hear the heartbeat, and WhatsApp everyone the first images of your little jumping bean.

Not so fast: here in The Netherlands you’ll have to wait until you are at least 12 or 13 weeks along. No-one is really interested in seeing you before then. You may call your huisarts (family doctor) to tell them you are expecting, and they will advise you to find a midwife.

• In some cases you may have an early viability test at around 8 weeks. This is usually a vaginal ultrasound to establish if there is a heartbeat and that the pregnancy is not ectopic. This was not my experience.

You’ll see a midwife not a doctor.

For normal, healthy pregnancies you will be attended to by a midwife the whole way through. You will not see a doctor, OBGYN or Gynae. Once you have confirmed that you are pregnant (ie. taken multiple home pregnancy tests) and called your family doctor to let them know, hop onto Google and search for a midwifery practice in your neighbourhood. Look at their website, read some reviews, post in expat forums to get personal feedback, and once you are satisfied go ahead and register online.

I used Verloskundigenpraktijk Liva which is a well-known practice with great reviews. Make sure the practice you choose has experience dealing with expats. It will help you negotiate the birth you want.

You’ll see a different midwife at each visit.

This was a little strange for me. Having given birth in Turkey and South Africa, I was used to seeing one doctor the whole way through and building a rapport with her. Trust grows over time, and I was a little unnerved not knowing who I would see at my monthly check ups.

Even more strange is that you do not know who will attend the delivery. It all depends on which midwife is on call when you go into labour. In my case, labour started just as one shift ended, so the midwife who came to check on me at home was not the midwife who eventually delivered my baby.

The best advice I can give is to put your trust in whichever midwife you get. You are instantly bonded because you are women about to journey through the birthing process together. That goes way deeper than knowing each other personally.

You’ll only be offered two ultrasounds.

I guess this is normal if you’re from the UK or US, but for me, having been pregnant in developing countries where an ultrasound is performed every single month, it was a bit strange. Refreshing. But strange. Paranoia can creep into your mind: how do I know my baby is OK if I haven’t seen it every step of the way?

The first ultrasound will be done at 12 or 13 weeks. Your midwife will tell you where to go, but it is up to you to call and make the appointment yourself. In my case both ultrasounds where done in Leiden, a town about 20 minutes away from where I live.

Your second and final ultrasound will be the standard anatomy check at 20 weeks.

You can have the 4D scan done at around 23 weeks, but you will pay extra for this. I chose not to do it because the sonographer simply switched to 3D during the standard anatomy scan and printed out a picture. Was good enough for me.

The hands on approach.

So how do you know that everything is normal during your pregnancy? The midwives will do it the old fashioned way: by actually using their hands! They’ll feel your belly each month, they’ll feel the baby, feel the growth of your placenta, feel your water levels, and measure your bump with a measuring tape. Revolutionary right! Then they’ll listen to the heart beat with a microphone held against your belly. And most surprising of all they’ll actually ask you how you are feeling!

All joking aside, its a very calm and natural approach. Listen to your body, voice any concerns you may have, but try not to obsess over every tiny little thing. I loved this simple approach and I especially appreciated being asked how I felt. It’s a wonderfully holistic way of monitoring both baby and mother and I felt more connected to my body and my unborn baby than I have in the past where a doctor does and ultrasound and tells you everything is fine with no discussion.

The pregnancy and birth are free.

Check your health insurance. If you are on the Dutch system you may need to add on pregnancy insurance. There are different levels to choose from with varying costs. If you have the highest level of insurance, pregnancy and birth will most likely already be covered. Depending on your policy and if you stay a night in the hospital after delivery, you may be required to pay a small amount towards your overnight stay.

But, you’ll have to pay for any abnormality tests.

You will be offered the option of testing for chromosomal abnormalities such as Downs Syndrome and Edwards Syndrome. The test is called a Combination Test and is done by blood sample and ultrasound. Amniocentesis is no longer standard procedure so there is no risk of miscarriage. You are under no obligation to have the Combination Test. If you choose to have it and abnormality markers are found you will have further testing. Check with your insurance because in some cases older mothers may have the Combination Test done for free. Otherwise the cost is around 160 euro.

You’ll get a delivery box in the post.

An actual delivery box. A home delivery box. 30% of births in The Netherlands are done at home. So your insurance company will send you a box filled to the brim with everything you will need for a home birth. It’s exciting, if slightly unnerving, to unpack. You’ll find plastic sheets for your bed, gauze, disinfectant and umbilical clamps as well as other baby essentials such as alcohol, cotton wool, bath thermometers and a cute cuddly dummy holder.

Once you have your bundle of joy in your arms you can donate the remainder of your box to the underprivileged. Details for how to do this will be on the information letter found in the box.

You can choose where you will give birth.

You have the choice between giving birth at home, going to a hospital, or having your baby at a birthing clinic. About 30% of women opt for a home birth and it is considered normal. All ‘natural’ births, wherever the location, will be attended by a midwife. If you want any form of pain relief such as gas or an epidural, then opt to give birth at a hospital because home births are strictly pain relief free. If you do have an epidural in the hospital, your midwife will hand over to a doctor who will attend the birth.

Let me be clear: choosing to have your baby in a hospital does not guarantee that you will receive pain relief. If you are sure you want an epidural, be clear from the start, do your research well and choose a hospital used to dealing with expats. In my case I could choose between two hospitals, one where pain relief is readily available (because they are used to foreigners) and one where it isn’t (the one I ended up choosing).

Do a hospital visit.

Most hospitals have monthly open evenings where you are given an informational talk and a tour of the maternity wards. These events are in Dutch, but the nurses are happy to answer any questions in English. Pay attention to how you feel while you are there. Are the nurses happy and helpful? Is there a warm and welcoming vibe? Does the hospital feel big and scary or small and cosy? How well are the rooms equipped? Will you have a private room? Is there a minibar? (#kiddingnotkidding)

Pre-register at the hospital

If you choose to have your baby in a hospital it’s a good idea to pre-register at admissions a few weeks before your due date. This is as easy as taking your health insurance card and identity document and being officially registered on the hospital system. Now, when you race in at 2am in full labour you’ll already be in the system and can focus on the birth.

Be prepared to fight for pain relief.

I touched on this earlier, but want to reiterate it. In The Netherlands women give birth naturally. Epidurals are not the norm. If you know that you want pain relief be 100% clear with your midwife from the start. You’ll have two barriers to overcome, the first being the midwife (although she will support you in your choice), and the second being the hospital (slightly more difficult to do). I have heard of many instances where a labouring mother asks for an epidural and the anesthetist mysteriously is nowhere to be found until it’s too late.

The Dutch are strict, you must be less than 5cms dilated to be eligible for an epidural. Anymore and you’ve missed the window. In Turkey and SA I had a late epi at 8cms and no-one batted an eye. If this is your first baby you may have time as labour could be slightly longer. If this is your second, third or fourth (or more!) baby you’ll have to have exquisite timing because the hospital will not admit you until you are in active labour with regular strong contractions, and by that time you may be more than 5cms dilated, in which case no epidural.

Be insistent. Fight for what you want.

Buy your own labour outfit.

This one was weird for me. The hospital does not give you a gown to wear during labour and birth. You have to bring in your own birthing clothes. Your best bet is to pop into somewhere affordable like C&A and buy a long sleeping shirt or something similar. You’ll more than likely bin it after the delivery so don’t spend too much. Go for practical and comfortable. Remember to take some big granny panties and socks too.

Overdue? No Problem!

You will be allowed to go at least two weeks overdue. Your due date will be an estimation anyway, and so there is no major panic if you’re still pregnant at 42 weeks. You’ll see your midwife at 38 weeks, again at 40 weeks, then every week until you deliver.

 

Attitude is key.

The Dutch are wonderfully functional in their attitude to pregnancy. Everything is normal, so why act differently? It’s refreshing. Here are some other insights into the Dutch attitude to pregnancy:

Doe maar gewoon, dan doe je al gek genoeg!

This is a common mantra in many areas of Dutch life. It means: just be normal, that’s already crazy enough! Normal is the key. Be sensible but not over sensitive and everything in moderation.

You are pregnant, not sick.

Pregnancy is not seen as a condition. It’s a normal part of life.

Carry on as normal.

Dutch women ride their bikes til the bitter end. I rode my bakfiets til the end, and besides being slightly more out of breath, it was totally fine.

Age is relative.

Over 40? So what. Dutch women are having babies later than ever. You may be considered ‘old’ in your home country, but here, you’re still a spring chicken! That being said, if you are an older mother, do your research on fetal abnormalities and the Combination Test.

Everything in moderation.

Cheese, coffee, good quality sushi, the odd glass of wine, exercise! Just be sensible.

 

Read Part Two about Giving Birth in The Netherlands.

Read Part Three about Postnatal Care in The Netherlands.