Tuesday, 1 April 2014

7 reasons why prenatal care and giving birth in the Netherlands is awesome!

Alrighty folks, I'm going to finally do it! I'm going to write about something related to being an expat - my experiences with prenatal care and childbirth here in the Netherlands. 

Before I do, I will write a short disclaimer as this can be a topic that women (and men) have very strong opinions on - I am only sharing what works for me, what is a good fit for me and my family. Although there are a few points that I do believe every country should adopt from the Dutch, I'll be specific and keep this post positive! 

What I loved about my birth experience: 


Welcome to mommyhood: having a baby in the Netherlands


My prenatal care and childbirth was 100% covered by my health insurance


After learning that I was expecting, hubby and I weren't sure if I should deliver in the US or in the Netherlands. Both options were available to us, and the decision came down to finances for the type of birth experience we wanted. Both countries have excellent medical systems in place, but both countries approaches to health insurance are not created equal. 

My medical expenses were completely covered in the Netherlands - we paid nothing out of pocket (and all children until the age of 18 have free health insurance, just saying). 

Every single medical procedure, every single class I took, everything was covered by my health insurance. And the quality of care was excellent. 

The reason why we didn't have to pay anything (instead of a small fee) ties in with the next points, the use of midwives and the approach to childbirth here. I do have to say though, even if it wouldn't have been 100% covered, the amount of money we would have had to pay ourselves would have been very reasonable. 

Midwives and natural childbirth 


Unless a woman has a high risk pregnancy or some kind of complication with her pregnancy, she will go to a midwife here.  

I went to an office with four midwives. They rotated shifts, and you couldn't really know which one you would get when it would be time to deliver (can be a drawback). I didn't mind that because I was comfortable with each and connected with them. 

There are a few options as far as medical care providers for prenatal care, labour and delivery:

  • Home birth with regular midwife/midwives (common) 
  • Hospital birth with regular midwife/midwives (common)
  • Hospital birth with on staff midwife/midwives (non-emergency medical procedure will become necessary. This is what ended up happening with me - I needed to have medicine to increase the progression of contractions, not pitocin but something similar.) 
  • Hospital birth with OBGYN (emergency situation or high risk pregnancy, rare) 

Midwives are specifically trained in helping women with normal, healthy pregnancies. Doctors are trained in delivering high risk pregnancies.

When a woman thinks that labour is starting, she can give her midwife a call, and the midwife will come over and check things out. The midwife give instructions to the family, and then she'll leave. As things progress, the midwife will be called again, at which point, she can assess the situation again. If there is a problem, the labouring mother will be sent to the hospital. If everything is looking good,a home birth will happen. 

A natural, unmedicated childbirth is generally advocated here (within reason) and the following is typical regardless of a hospital or home birth: 

  • No IVs
  • You can walk around
  • You can eat 
  • You don't have to labour on your back, but can choose your position
  • Water births are available
  • Home births are common (health insurance covers a free package of homebirth supplies sold at pharmacies) 
  • C-sections occur at about half of the rate in the US
  • Inductions happen at a threat to either mom or baby, and will not be considered otherwise until the mother is 42 weeks along
  • Waiting room warriors aren't allowed 
  • Visiting hours are limited
  • Women and babies can typically go home from the hospital a few hours after delivery
  • No shots for the baby (vitamin K and vitamin D drops are given to children instead) 

The way it works with (many) health insurance providers is that a home birth is covered 100%, but you may 'rent' a room in a hospital to deliver there with your midwife. However, if you have a medical reason to deliver in a hospital, then the health insurance will cover the hospital room. 

I had dreamt of having a natural, water birth, but wasn't able to. My midwife realised that there was a problem with the way my labour was progressing, reacted very quickly, calmed my panic attack, and accompanied my husband and I to the hospital. We drove all of two WHOLE minutes to get to the hospital from our home.

Because it was medically necessary for me to deliver in the hospital, my health insurance paid my entire hospital bill (about two or three thousand euro for all labour, delivery, and hospital stay related expenses). Otherwise, if memory serves me correctly, I would have paid no more than a few hundred euro if I had elected to deliver in the hospital for no medical reason. 

I can a say a lot more about this point, and my personal experiences with this differ from many of my friends in the Netherlands and in the US. I've spoken about this with many of my Dutch and expat friends here in Holland, and my experiences basically fall in the middle of all extremes. I'll leave it at this last story, and get on with it!

Story time: I remember going on a trip to visit my family in the US while about two months pregnant. 

I was told by a doctor there that because I am petite (at 5 feet 1 inch tall) that I would have to have a c-section. 

I know some women have difficulty with a vaginal birth and that babes can get 'stuck', but, really? Just because I'm short? You can tell that by looking at me with no medical test/exam at two months along? That statement sent me into an absolute panic. When I asked my midwife if this was true, she laughed. Out loud. She reassured me that not only was it far too soon to tell, but that there are plenty of women shorter than me that are able to have natural deliveries. Okay, nerves = calmed. Rationally, I am now assuming that most doctors in the US have actual medical reasons for recommending c-sections other than a woman being short. Right????? 

Paternity leave


My husband was home for 4 months with our son. 

Next time around, we won't be able to do that. What we will be doing is: he will take a few weeks (paternity) leave, then he will be working part of the week and using vacation days the for the remainder of the week for about a month. We're lucky to have these options, even for Holland. I think typically, men only get a few days paternity leave. 

Generally speaking though, the Dutch do have a much better work-family time balance than in the US. I've really been amazed by this in the four years I've lived here. 

Kraamzorg


This is the good stuff. This is the reason (along with the next point) why I want all of my future children to also be delivered in this country. This is the only point in this post where I will say that the Dutch way of doing things is better. 

So what is it? Kraamzorg are Dutch mothers helpers or maternity nurses for families with new babies for 8 hours a day for 8 or 9 days after a baby is born. 

Every woman in the Netherlands is entitled to 49 hours of Kraamzorg. 
These awesome helpers will come to your house and do (almost) annnnyyttthing: 

  • Clean
  • Cook
  • Do laundry
  • Buy groceries
  • Take care of older children
  • Take older children to school and pick them up from school
  • They are lactation consultants 
  • Offer post natal maternity care
  • Make sure that baby is developing properly
  • Change diapers
  • Care for baby so mommy (and daddy) can sleep
  • Offer advice for caring for baby 
  • Chat with mommy 

Basically, these Dutch angels make sure that everything post baby is going well. They make sure that the family is adjusting well, that everyone is happy, that the mom is emotionally healthy (ie - help to spot baby blues or PPD and offer appropriate advice), and make sure that the family can focus on the baby rather than household tasks. 

Sounds expensive, right? Nope. It costs about 2,000 - 3,000 euro (again, if I remember correctly. If you are curious, let me know and I will look up how much mine cost). However, your out of pocket contribution is typically 4 euro an hour, although some insurance companies (like mine) cover more. I paid a total of zero euro. 

Postnatal care is at home


This is another point where I think the Dutch have really got it going on. Standard post natal care is at home. At one week post partum, there is no need to get your barely healed self into a car and take your newborn babe over to a doctor's office with potentially sick children for a checkup. 

Here, the midwife will come to you!

I really loved that I was able to stay at home and heal until I felt ready to get out and about! My midwife stopped by a few times to make sure that everything was going well, to check the babe, and basically do everything that would happen during a checkup. 

Another medical 'person' also visited once to conduct a hearing test and take a blood sample when the babe was a week old. 

Choice


Very simply and concisely put: I felt that I had the financial freedom and ability to make decisions and choose the type of care and approach to my pregnancy and delivery that I felt comfortable with. I don't know if I would have felt the same way in another country because I've never delivered in another country. But I liked the choices that were available to me because there were a) many and b) they were all affordable.



Phew! That sure was long! I hope you found this remotely interesting and not just a rambling list! I have so much more I could share on this topic, and a lot more of my personal birth and care choices and experiences that I could explain. 

I will say that I really did love the approach here, and I will be very comfortable when the time will come for number 2. Some of my friends did not have good experiences here, while others had much better ones. I think with things like this (childbirth, medical care), it's all very personal and depends on so many factors that what's right for one person won't necessarily be a good fit for another. 

I'd love to read about the different approaches to prenatal, delivery, and postnatal care in your countries or your own experiences, too!  

If you have questions about the Dutch system, midwives, my labour and delivery, comments, etc, please let me know! I'd love to hear from you! 

As usual, I am linking up with Angie at Many Little Blessings and Kris at Weird Unsocialized Homeschoolers for List it Tuesday!

Thank you so much if you got through all of that!
Yuliya