Giving birth in the Netherlands: an expat’s story

iStock_000013346403XSmall

The readers of The Skeptical OB are the best, most interesting, most articulate folks on the web. Here’s a guest post from reader and frequent commentor Olga Mecking. Olga is a Polish woman living in the Netherlands with her German husband and three trilingual children. She is a translator, trainer in intercultural communication and writer. She blogs at The European Mama, a blog about her experiences of living and raising children abroad, culture, language and parenting.

For many reasons, the first time I was pregnant, I received care in three different countries, including my native Poland, Germany (where my daughter was ultimately born) and the Netherlands. My first child was born in Germany after a long and grueling 38 hours of labour.

When I got pregnant the second time, I was living in the Netherlands and received my pregnancy care from Dutch midwives. For reasons that made sense to me at that time, I wanted to have a homebirth and felt supported in this decision. I figured that the Netherlands are the perfect place for giving birth outside of the hospital. The idea is that birth isn’t an illness and doesn’t require a special doctor. OBGYNs work in hospitals, and only care for high-risk pregnancies. If a midwife finds out that something is wrong, she will transfer the woman to a doctor.

My second pregnancy went very smoothly, if I forget about the horrible heartburn. The midwives told me it’s normal and so I didn’t get any medicine because I was afraid I’ll hurt my unborn child. However, they did regular urine tests, 3 blood tests and as many ultrasounds.

Al the time, I was scared of having another hard birth. My first daughter weighted 3600 grams. It’s nothing out of the ordinary but for a petite woman like me, she was huge. I felt torn between my desire to have a peaceful, calm homebirth and having immediate access to a C section if it was necessary or I chose to have one. In the end, I went with the homebirth, but when my water broke one day after my due date, the midwife came to check on me and told me that I have to go to the hospital and will be cared for by a second-line midwife- one that works in the hospital and takes on more complicated cases. As we are expats, we didn’t have anyone to take care of our daughter during that birth and we took our big girl with us. No one batted an eyelash though, they gave her a bed and some toys.

My midwife brought us to the hospital and disappeared because she was not allowed to care for me anymore. The new midwife and her assistant monitored my daughter’s heartbeat. I wanted at least to have the freedom to move around and they agreed to insert an internal monitor that was attached to my baby’s head, and it didn’t restrict my movements. During transition, I asked for an epidural- I was in pain and didn’t know it was transition. The midwife said that she’ll get it and disappeared. She only came back after I called her in and told her I needed to push. It would have made a world of a difference if she told me that it’s going to be over soon. But my little girl was born without any problems just a few pushes later. Because there was meconium in the water, they kept us in the hospital for the night.

When we came home, we were visited by a special maternity nurse, called kraamverzorgster in Dutch. While I was skeptical of letting a stranger into my house for 8 hours a day for a whole week, she proved to be a huge help. She cleaned the floor, prepared my favourite tea, made our bed and took care of my big girl while I showered. But above all, she made sure that I and my baby were fine: took our temperatures, checked my uterus, and weighted and bathed the baby. She made sure that breastfeeding was going well. She also run errands for me. While there are many problems with maternity care in the Netherlands, this is where the Dutch really get it right. After 8 days I was on my own again, but felt that her support helped me adjust to the new reality with two children.

Between the time I had my second and my third child, many things changed. For example, with this last pregnancy, I was no longer offered urine tests as they would only do them when elevated blood pressure was present. This time I had my eyes set on a birth clinic that was located in another hospital.

I still had the blood tests and ultrasounds (the midwives do the ultrasounds but for the 20 weeks scan you have to go to a special ultrasound clinic). When I found out that the baby is a boy I was scared that he’ll be big. The midwife told me that I can have a baby of about 4 kilo. This did nothing to alleviate my fears I and wanted to discuss the possibility of an elective C section but they wouldn’t have any of it. The midwife told me there is no medical indication for the operation.

Frustrated by the lack of support, I contacted a doula. We wrote a birth plan and talked about my expectations for this birth. In the end I realized that I didn’t want a certain type of birth, I just wanted my baby to be healthy, and to be healthy myself. On my birth plan, I indicated that I may want to get pain relief but when I called the birth centre to ask what they would do if I wanted pain relief, I was warned than then the birth would become medicalized and I’d have to go to the hospital and they made it sound like that was the worst thing that could happen to me.

My contractions started 9 days before his due date. The day before, my doula gave me a massage and I think that it helped start labour. This time we had friends to take care of the girls while we were in the hospital.

I called everybody: my husband, the midwife and my doula. My husband and midwife arrived almost at the same time and then my water broke. Again, it was thick with meconium. Again, I got transferred to the hospital. I informed my doula of the change of plans and we met at the hospital where again, my midwife told me she had to attend another birth and left me. Luckily, the team I got this time was amazing: this time I had a very friendly OBGYN and equally friendly nurses.

This time, I didn’t want to breathe through contractions: I just wanted to be comfortable. Since I was already in the hospital, I asked for a pethidine shot (I was progressing very quickly and an epidural was out of the question). I got it without any problems. The pethidine took the edge off the contractions, allowing me to relax more. My son was born shortly after that. He swallowed some meconium and was blueish at the beginning but soon pinked up. We went home the same day (although we stayed for dinner at the hospital) and again had an amazing kraamzorg.

I am very lucky that my babies were born alive and healthy. The care I got here was much better than I would have had in my home country, Poland. But it leaves a lot to be desired: for example women’s wishes for pain relief may easily be overridden by her midwife because she can’t administer it (midwives now can give sterile water injections and gas and air, and second line midwives can administer the pethidine shot, but for an epidural, an OBGYN and an anesthesiologist are required). I had to fight a lot for my needs to be met and I wish I didn’t have to.

It’s nice to have a midwife care for you during pregnancy, but if something’s wrong, you need to get transferred to a hospital. This means that the moment you are scared and at your most vulnerable, you have to change care providers, which only adds to your stress.

The system seems to work really well for women who have no problems during pregnancies and expect to have a natural birth. It also works for high-risk women who are taken care of by specialists- for example after previous pregnancy loss. But I guess the most cases fall somewhere in the middle and I wish such women wouldn’t be so pressed to have a natural birth and instead, would be offered more choices.

  • Well, then you were lucky! I had problems with my kidneys already during my first pregnancy in my motherland. So they also did urine tests very often. But during my second and third pregnancies in the Netherlands they never did even a single urine test even though I insisted many times and explained them my situation. I was just told to drink more water… Also not that happy that they kick you out of the hospital after a couple hours after giving birth if everything is fine. And our kraamzorg lady was a disaster: was only drinking tea with my husband and writing down smth in her notebook. Also my only request was a person with a good English and we were sent a lady with almost zero level…

  • lopsee

    My husband and I, with our 3 years old son, are planning to move to Netherlands. My first was a c-section. I have heard that none of the health insurance covers c-section? I am not given a choice and am forced to do VBAC? Is all of this true? Cause I would like to have the second child via c-section as well. It is scaring and stressing me a lot. I am thinking, should I give up my right to have a second child cause I am not given a choice of method of birth? Can anyone suggest me any health insurance that covers c-section?
    Thanks

    • laura

      HI, My first child was born by a medically necessary cesarean in the UK. It is your right to have another. We have a good insurance package with CZ and they are covering it but check when you register with health insurance. I had the same concerns as we relocated just last year. I found the midwives quite pushy in certain ways and were negative about cesarean, and really pushing for me to try VBAC and hailing the negatives of cesarean recovery. i don’t understand why they do it because it certainy doesn’t make those women who ultimatley HAVE to have cesareans feel good. If you find a good hospital, do your care there, i have found a good hospital in Amsterdam and have a cesarean booked for 4 weeks time and everyone at the hospital is lovely and making me feel good about my situation. If you go to your doctor, say you have had a previous cesarean and it is your wish to have another, they will transfer you to a hospital for your care throughout your pregnancy. Good luck! x

      • liz

        Thanks for sharing Laura, you must be due any day now and would love to hear how it went as im a concerned pregnant soon -to-be SA expact in Netherlands. Would love to get more details from you re Hospital name and caregivers. Wishing you and baby a healthy delivery!

  • Julia B

    I am also living in the Netherlands and expecting my second child, first born in the US. I especially chose a midwife associated with a local hospital because the “norm” here for low-risk pregnancies is a home birth, however I prefer to have a hospital birth and I wanted to have that clear from the outset. For women who choose hospital birth in the Netherlands without a medical reason, there is actually a co-pay of around 200 euros as health insurance only fully covers a home birth for low-risk preganancies. I can afford this amount, and I consider it to be money well-spent as I would hate for my baby to wind up dead or with serious complications if something unexpected happened and I needed an emergency Caesarean section within a few minutes. However, there are concerns that low-income women are financially ‘coerced’ into home births and their infants suffer higher rates of neonatal complications due to this policy.

    At the particular hospital in which I am planned to give birth, it appears that they have 24/7 epidurals available. This is probably due in part to the large expat community living close by, and also forward-thinking attitudes from this particular hospital (they also arrange for women to have the NIPT test, which is not yet available in the Netherlands, for example). I had an epidural with my first and it was a good idea. I will use it again if I think I need it. Denying women the most effective pain relief during labour and delivery seems rather barbaric.

    • newinams

      Hey Julia,

      I know you posted this a while back but I thought I would try to reach out anyway. Could you please provide the name of your midwife and hospital? You situation sounds ideal. I will be giving birth to my first child in the Netherlands, if all goes as planned with the move and getting pregnant. I’m a US expat so I want it to be relatively similar to what I would expect there! Thanks!

      • Julia B

        Dear Newinams,
        You are welcome to contact me about giving birth in the Netherlands. I am around 32 weeks now, so I have been through most of the prenatal care, and I can compare with the US experience (at least, my US experience…). My email is juliainnederland@gmail.com so feel free to drop me an email.

        • liz

          Hi Julia, im a South African expact expecting my second child. We are relocating to Netherlands in 3 mnths. Im 34 years old and had complications with first birth 22 mnths ago and needed emergency c-section. The norm in SA seems very much the same process as in US and am nervous re midwives pushing for VBAC in Netherlands and finding a good hospital and OB/GYN Do you mind sharing your experience as im sure your baby is born now and pray you are both healthy

          • Julia B

            Hi Liz,

            Sure, my baby boy is now almost 8 months and doing well! I didn’t have any complications during pregnancy, so I don’t know how well my experience would compare with your situation. To sum up, I planned to have the baby in the hospital from the outset. I had a healthy pregnancy and carried my son to week 39. About 24 hours after my waters broke, my contractions started, I went into the hospital a few hours later, then my son was born about 6 hours after the contractions started. As I had ruptured membranes for more than 24 hours, I stayed in hospital for a day for observation. Normally women with uncomplicated childbirth are sent home a few hours after they give birth. Then their care is taken over by the “kraamzorg”. The “kraamzorg” is excellent. Never has my bathroom been so clean!
            I felt that the midwives in the unit associated with the hospital went out of their way to help with some of the uncomfortable parts of pregnancy. Compared to when I was pregnant in the US, the midwives took their time to talk about my concerns. I only had a couple of issues from my care where I think it may have been different in another country. I wasn’t happy with the glucose screen done at around 20 weeks as it was a single non-fasting sample. I would have preferred the OGTT like was done in the US, as it is more sensitive.
            I also was counting on having access to epidural if I needed it. Well, in theory the hospital had 24/7 access to epidural, however if the midwives think that labour is progressing quickly and you are dealing with the pain well enough, then they don’t wake up the anaesthetist at 5 am to get you decent pain relief. I had to make do with a pilates ball and shower to get me through the last hours of contractions, which I was not too happy about. Luckily my son came out quickly.
            My friend had a planned c-section for her second pregnancy here. Her first baby had the umbilical cord around his neck (they saw it on the ultrasound) and was born via c-section. She discussed the risks and benefits of VBAC and for her, the risk of the uterus rupturing during labour was enough for her to choose a second c-section. She didn’t feel pressured to go for VBAC. But it may depend on the midwife unit. Try to choose one that is not going to make this an issue – maybe go for one that has a “family-friendly c-section” program (gezinsvriendelijke keizersnede)

  • Marfoe

    Being an expat in the Netherlands myself, I really enjoyed reading your experiences here. Thanks for sharing! The “kraamzorg” (post-natal care) with a nurse at home is just great, but consider me unimpressed with the rest of the pregnancy care.
    I knew that I wanted a hospital delivery (if possible with an epidural) all along. And that’s when it got tricky, since a lot of the hospitals here don’t provide with epidurals out of office hours. Fortunately, I am not far from a big city, so I got to give birth in one of the best hospitals in the country equipped to deal with all kinds of emergencies and 24/7 pain relief, ha. Everything went fine, and we were kicked out at 3 or 4 in the morning (yes, really).
    They didn’t make it extremely difficult for me to get the care I wanted, but I had to hear the lecture about the apparently huge risks of epidurals a few times. I informed myself a bit, and a lot of the things I read or heard from the Dutch sources didn’t make much sense to me. Like, one of the disadvantages was “but then you and the baby will have to be monitored during the whole delivery!” (If I had any doubts, that would have convinced me to totally go for the epi.)

  • yentavegan

    Thank you for posting your experiences giving birth in Europe. Here in the USA women who hire non-hospital affiliated midwives do not get the quality of care you and your newborns received. Your 3rd child inhaled meconium. Since you delivered him in a hospital there was trained medical staff at the ready to treat and stabilize your newborn.
    In another place and time, you would have gone home empty handed.

    • Yes I was lucky- actually all of my children inhaled meconium and all of them were delivered in a hospital and al of them survived- they were all monitored and luckily the heartrate was always good. I am so happy that they were born alive and healthy. PS, the healthcare in Europe depends on the country- the care in Germany is totally different than in the Netherlands.

  • Anna D

    I have a question. If you have a low-risk pregnancy in Netherlands can you go to a doctor for your routine care and a hospital delivery with an epidural?

    • Why would you want to have a doctor do your antenatal care? Or your delivery, leaving aside, for the moment, the question of epidural?

      One of the major differences in “obstetric philosophy”, if I may call it such, between the US and just about everywhere else, is the concept that ONLY a doctor, especially a private doctor, can provide adequate care in non-complicated situations. If a woman in the US says “Dr. Jones delivered all my babies!” everyone thinks that’s perfectly normal; in Europe if she says that to her friends, everyone will look sympathetic and reply “What went wrong?”

      It is true that different countries use midwives in different ways. Here in Israel they are almost exclusively hospital-based while in the UK and Netherlands they work both in community and hospital settings. But they are the “go-to” persons who have autonomous responsibility for pregnant women as long as the pregnancy and labor are uncomplicated , referring to doctors only when clearly defined parameters are exceeded which indicate that complications are developing. Doctors and midwives are collaborators in care, not “superior” and/or “inferior”.

      If a woman wants an epidural, that does not preclude her being delivered by a midwife, but at least one doctor will be associated with her case [OB and anesthesiologist, who places and maintains the epidural].

      • Irène Delse

        Different countries in Europe use midwives differently, indeed. And not all countries where midwives work with doctors have this model of midwives as gatekeepers to pregnancy car, as it looks like the Netherlands have, from this article.

        In France, afaik, even though midwives are the backbone of the childbirth and prenatal care across the country, most women are also seen by an OB/GYN at least to assess the state of their pregnancy, their risk factors, etc. Women who have no risk factors have generally one or two visits to the doctor and go on to give birth with midwives, unless something happens and changes the status of the pregnancy. Those who have known risks are followed more closely by a doctor and they are booked into a high level hospital for the actual delivery, but even then, midwives do part of the prenatal care, for instance childbirth preparation classes.

        I’ve seen that with a friend who had a pretty uneventful but still risky pregnancy (primipara at 40yo) and she had several doctor appointments for tests, but also had guidance before and during birth by midwives. The day of the actual birth, she went to the hospital and was seen by a midwife who checked that she was indeed going into labor, admitted her and called the OB, anesthesiologist and neonatologist just in case. The anesthesiologist ended up being needed for an epidural but not other doctors.

        Btw, here, I’ve never heard women say ‘Dr. X (or midwife Y, for that matter) delivered my baby’, but ‘I had my baby at hospital or birth center Z’. The assumption is that there will be team work.

        Honestly, I don’t know personally how good that model of care is, and there are of course a lot of handwringing about costs, as for everything these days. I do know that the perinatal mortality numbers are not as good as in other developed countries like Sweden (but about the same or a little better than the Netherlands, last I looked). For one thing, that division of labor between doctors and midwives mean that there’s the potential for miscommunication.

        But what I find disquieting is the current trend we’ve been seeing here recently of renewed turf wars, started by midwives who want ‘more autonomy’ and use the ‘specialist of normal birth’ kind of rhetoric. In effect, they want to be able to practice out of hospital with no supervision and become sole providers for ‘normal’ pregnancies. As if there was a clear-cut division between normal and abnormal… Only shades of risk.

        • Hiro

          I’m currently pregnant and I live in Paris, and I’m being followed entirely by an OB. I haven’t had any appointments with, nor has it been suggested that I see a midwife. They may spring a surprise on me maybe at the birth but I am currently under the impression that my OB will be at least nominally present at the delivery.

      • Anna T

        That’s quite true – I gave birth in Israel twice (so far!), and all my monitoring during labor, cervical examinations, and the delivery itself were handled entirely by midwives. Everything was smooth and uncomplicated and I didn’t want an epidural, so there was nothing a midwife couldn’t handle.

        • Yes, the doctors are always there. They just don’t interfere unless needed. In the UK, during my time there, I was under no obligation to even inform staff OBs as long as my patient remained within permissible parameters. I found that there is less autonomy in Israel than in the UK for midwives, a fact that occasionally I found frustrating. Usually the doctors [especially once they knew my capabilities] left me pretty much alone, but occasionally, while I was the person at the bedside, some doctor would parachute in and decide a course of treatment I thought unnecessary or even inappropriate. I remember one Russian doctor in particular who believed every primip should have an episiotomy, while I made the decision on an individual basis.

          My experience in the US, UK, and Israel with private doctors is that they generally do not appear before the woman is near delivery. In the US, the resident would get his orders from the OB when he notified him/her that a patient of the OB had come in, and then transmit the orders to the L&D nurse [RN]; in the UK and Israel, the OB gives the orders to the midwife. It is the nurse or midwife who actually attends the patient for nearly the entire duration of labor.

      • The birth philosophies in Europe depend on the country. For example, in the majority of European countries, doctors are the go-to care providers, no matter if the pregnancy is low risk or high risk. In the Netherlands, yes if you say that you went to a doctor, everyone will think there was something wrong with the pregnancy. Dutch women are more likely to go to a mdiwife because that’s hwo it’s always been and they’re very likely to know someone who has had a homebirth, or they were even born at home themselves.

        • Amy M

          What about women who conceived via ART? Are they automatically considered higher risk shunted over to doctors? Do you know where the general lines are drawn in terms of risk? Like is maternal age (over 35) considered a factor, GD? I imagine they don’t fool around with pre-e, PIH, multiples or breech. At least I hope not. (I mean in the Netherlands here)

          • I don’t know about ART but maternal age, twin pregnancies, breeches, pre-eclampsia, GD are considered risk situations.

          • Ellen from NL

            Thank you very much Olga for sharing your experience!

            Long-time lurker, first-time poster from the Netherlands (born and raised) here…

            Although I have no personal experience with ART (nor with homebirthing…) I know from friends and colleagues that women who conceived through ART are free to choose to have their antenatal care provided by an OB/Gyn or a midwife as long as they remain ‘low-risk’ (no twins, breech, previous c-section, PPH, etc.). Thus, it is perfectly possible to have a homebirth after successful ART (although I personally have difficulties getting my head around that).

            I was almost 36 when I had my 2nd baby, and this is generally not considered a reason to not have a midwife care for your pregnancy. It is deemed sufficiently high-risk though to receive (voluntary) 1st trimester screening (triple test) free of charge.

      • auntbea

        Why WOULDN’T I want a doctor for antenatal care and delivery?

        • AllieFoyle

          Agree. I can understand a woman feeling like the midwifery model is a better fit for her, but what’s wrong with wanting a doctor to provide your care?

      • theadequatemother

        I had the choice of midwife (all here offer home and hospital birth), GP obstetrics or an OB. I not only wanted a doctor, I wanted an OB. I wanted someone, even though I was low risk who could look after everything. I didn’t want to have to change providers if my pregnancy or labour became abnormal or if I needed a cs.

        By choosing my OB, I could also choose someone who had similar risk tolerance to myself. I had the advantage of knowing all of the OBs in the city from my training days and I knew who was conservative and who was more “optimistic.”

        The biggest issues by far for me were:

        a) the midwives here place extraordinate value on vaginal birth that I didn’t
        b) the midwives here seem to suffer an excess of optimism bias in pursuit of the above goal and I had seen that bias on two occasions during training result in intrapartum or early neonatal death.
        c) If I used a GP who did obstetrics I would still have the same problems regarding transfer of care during pregnancy or potentially during labour
        d) I can return to my OB/GYNE without another referral for a year after the birth…makes it super easy to get IUDs (some GPs do them some don’t), and have my pelvic floor checked out (GPs tend to refer these problems and that can take 6+ mo to see a gyne).
        e) I could establish early with my OB the amount of uncertainty I was willing to tolerate in labour before moving to a cs (very little).

      • Anna D

        Well, while I am fine with going to a nurse/midwife for routine appointments and tests, I would like to have an OB taking a look as well just to make sure nothing is missed. Also, from reading various stories, Olga’s included, it seems that midwives are more prone to ignore requests for interventions or pain relief.

    • You can definitely have a hospital birth with an epidural. But then your midwife won’t be able to care for you and you will need a doctor (plus anasthesiologist) at the birth. The midwife, however, will still be the one to care for you during pregnancy (and obviously, she will make sure that you know “all the risks”.

      • Anna D

        Thank you Olga. It just seemed from your story that perhaps it was not done in Netherlands and at the very least very unusual.

        • Obviously they have doctors and epidurals. It’s just an epidural is seen as a medical indication and so requires a doctor and midwives would try to persuade you out of it.

  • fiftyfifty1

    Thanks Olga M. I always enjoy reading your comments and appreciate hearing about your experiences.

    • Thank you for your kind comment and I am very glad that Doctor Tuteur allowed me to share my story.

  • Ob in OZ

    excellent post and discussion

    • Thank you. I am loving this discussion as well- and may I tell you how happy I am to meet all of you through this blog!

  • Jessica S.

    Excellent story! Thank you so much for sharing, and thanks to Dr. Amy for providing the platform!

    Can I just say (I assume it’s been echoed numerous times already!) that the special maternity nurse sounds like a *dream*. Is that offered through their health care system?

    • Oh the maternity nurse is a dream indeed! Yes it is offered through their healthcare system, although it depends on your package (some insurances pay for everything, others just for a part of that care). You can also choose to have a minimum of hours and are allowed to have more if there are problems. I think 48 hours (over 8 days) is the minimum, we ended up having 56 because we had two other children to care for. We had to pay for a part of it ourselves but only because we wanted more hours than it was usual.

    • Ellen from NL

      I (long-time Dr. Amy fan from the Netherlands) wholeheartedly agree with Olga that the maternity nurse system is great. Technically speaking the kraamverzorgster (which is a female noun, but there in fact a few male maternity nurses in NL) is not qualified as a nurse, meaning that he midwife has the final responsibility for mother & baby’s wellbeing (up until 6 weeks post-partum if I’m not mistaken). It is also the kraamverzorgster who assists the midwife in case of homebirth (in hospital birth it’s a usually L&D nurse).

  • CanDoc

    Super interesting, thanks for sharing!

    • Thank you for commenting! The Netherlands are a hot topic here so I thought I’d share my experience how giving birth here was for me.

  • Such a fascinating read. Thank for sharing!

  • Anna T

    The maternity care nurse sounds like a heaven-send! I wish we had something like this here. We do have a custom of all the neighbours taking turns to bring a meal for the family with a new baby, but it would be so nice to have someone helpful around the house too.

    • theadequatemother

      Our health system can’t even figure that out for the frail elderly. IMHO in your own home elder care just punts health care costs onto families.

      • We live close to a house for the elderly. They seem happy and relaxed and active. They go for walks, and take art classes. There are always nurses there. It looks like a nice place to stay when you’re old.

    • It is a heaven-send! And I too wish all women who has just given birth had someone like that to help them figure out these early days.

    • ModerneTheophanu

      I gave birth 3000 miles away from everyone I knew when I had my son, and that maternity nurse would have been an absolute godsend! Doing it completely on your own (no family or friends to help) is absolutely terrifying.

  • lawyer jane

    Interesting! To be honest, I think I would have traded my epidural for the kraamverzorgster, if I had to! (Not that anyone should have to.)

    • fiftyfifty1

      oooh not me!

    • CanDoc

      Me too!
      (Wait a second… I didn’t get an epi because it was too late, AND I didn’t get a kraamverzorgster. Damn!)

    • hahaha! That’s a high prize to pay but one I’d consider as well. But I wish we had easy access to both.

  • Trixie

    Is there any evidence for sterile water injections being effective?

    • Dr Kitty

      No.
      The UK has removed them from the list of recommended analgesics during labour.

      • araikwao

        Ha, I bet they’re still on the NCB-flavoured list of MW-approved options for analgesia here (but I’m not sure).

        Dr Kitty, this is an apparent non-sequitur (although it follows just fine in my mind, as I’m thinking of a friend who thought the sterile water injections were great, and also suffers a lot with endometriosis, as I seem to recall you do too..), but this friend has recently started “the Endo diet” (vegan, and GF, perhaps with a side of quackery, too?). AFAIK, there is no evidence for dietary interventions in endometriosis, with the possible exception of low-FODMAP, due to overlap with IBS. Do you know anything more on that?

        • Mariana Baca

          I think since it is theorized (proven? not sure) that endometriosis is an autoimmune condition, other autoimmune conditions, like allergies or celiac, may be comorbid. This won’t treat endo, but might relieve discomfort if other things are present. That is the only reasonable mechanism I’ve heard for the diet being helpful (other than by relieving ibs type symptoms).

    • Medwife

      It’s such bullshit. I’ve never done them myself but I was outside a woman’s room when it was administered to her and, well, the screams echoed through the halls. My guess is they are so acutely painful that for a little while contraction pain is less noticeable,

    • PrimaryCareDoc

      I’ve never heard about this before. Is this really administered as some kind of pain relief? Does it just “work” via the placebo effect?

      • Phascogale

        It only works on back pain in labour. Like if your baby is in the posterior position. It will do nothing for your contraction pain. The only women that get offered it are ones that have back pain. So it’s not ‘standard’ as such. And it works for all sorts of back pain. You don’t even have to be in labour! But very short term ie 1-3 hours of relief.

    • CanDoc

      Yes. Small studies have been done that compare intradermal sterile water with intradermal saline or subcutaneous sterile water, and the intradermal sterile water has a *slightly* better improvement in pain scores. BUT THEY HURT LIKE HECK going in… I’ve done them a few times and only one patient ever let me put in all 4 injections. It’s just that painful. (I do it when patients really really want it, but it’s terrible as pain relief.)

      • it seems like using pain to distract from other pain. Doesn’t make sense.

  • Mel

    Thank you, Olga, for such an interesting post.

    Helping people transition from the hospital back to their homes is a weak point in the medical system in the USA. My Oma (83 years old) was hospitalized with pneumonia for a few days last spring. The hospital took great care of her as an in-patient, but the discharge process was stressful for all of us. We had three hours notice that she was healthy enough for discharge. Thankfully, we had several able-bodied adults in the area who could help out on such short notice, but that would have been a logistical nightmare if she lived across the state or in a different part of the country.

    The craziest part was our “home safety check” with an occupational therapist.
    OT: “G, do you feel like you are ready to go home?”
    Oma: “Yes.”
    OT: “Alright, let’s get you discharged.”
    Me: “WAIT A MINUTE. Don’t you want to check to see if she can go into the house, dress, do basic hygiene, navigate the house, and feed herself safely?”
    OT: “Oh, yeah…um………………………(agonizing pause begins)
    Me (after I couldn’t take it any more): “Oma, I’m sorry, I can’t remember the layout of your house since I usually see you at (her daughter’s house). Can you tell me about how you get into the house?”
    Oma: “Oh, yes. [Explains how the house has been renovated so they can sleep, eat and bath on the first floor on one flat level.]”
    Me: Do you have carpeting, tile or rugs?
    Oma: It’s all that….oh, what’s the word……rough tiles. Non-slip!

    [This goes on for about 10 minutes. We decide she’s gonna sleep in the living room because she needed O2 and a power supply which wasn’t easily available in the bedroom. I offer to tape down the power cords to prevent tripping. My mother-in-law and I figure out how to divvy up meal prep for the next week or so. The OT is oddly silent during the whole thing.]

    Oma did fine, but I wrote a firmly worded letter about my concerns about the ‘health/safety’ aspect of that OT’s job.

    • Guesteleh

      A big part of the Affordable Care Act focuses on improving the transition from hospital and home. A key measure is rehospitalizations within 90 days. People often boomerang back to the hospital for preventable reasons: they can’t fill their prescriptions or they don’t understand to take their meds correctly or they can’t perform activities of daily living like shopping and cooking and there’s no one available to help them. Under the ACA, hospitals are penalized for high rehospitalization rates and are encouraged to partner with community organizations like the Visiting Nurse Service in order to improve post-hospital care. Anyway, long-winded but just wanted to point out that this issue is starting to be addressed in the U.S. but we still have a long way to go. And unfortunately the efforts are focused more on the elderly and not new mothers.

      • My health fund had a physiotherapist on my doorstep less than 48 hours after my discharge following my hip replacement. And prior to my surgery, I had to attend a group lecture in which we were given information on which, if any, home adjustments we’d need to arrange for. Israel has an organization, Yad Sarah, which provides all sorts of medical equipment for free loan, ranging from crutches, bedpans, wheelchairs, to even such large items as electrically-operated hospital beds for the non-ambulant. I borrowed a walker, and several special types of cushions which kept my hip straight in the initial post-op period. Total cost was a $10 deposit, which I later donated to them.

    • Jessica S.

      Outrageous that you had to bring up safety issues!!

      My mom had her hip replaced at the beginning of this year. The Group Health/Medicare advisor person called her THE NIGHT BEFORE HER SURGERY to tell her she probably wouldn’t be approved for any in patient rehabilitation care. My mom lives on her own and has no one who could’ve looked after her or taken her in. In the end, she was able to spend a week in a rehab facility, but she didn’t find this out until a few days after her surgery.

      I’m sure all of that is very normal and straight forward -they need to see how much help you might need once the surgery is over and the fog has cleared – but it really didn’t seem like a very humane way to handle it. Calling the night before her surgery?? It what scenario would that NOT be detrimental to the patient? Ugh. It all turned out ok, and it’s great to see her up and around and without pain now.

      • Young CC Prof

        After my father’s hip replacement, he had to be transferred from the
        hospital to a rehab facility. It was like 4pm on the day of his discharge before a bed was found for him. Then, they sent a van to pick him up wheelchair and all. For some reason, there was a $150 charge for this van, not covered, payable in advance. Of course, he didn’t have any money or wallet, luckily I was around.

        So many stupid friction sources in the system.

    • I don’t really know how it is for the elderly. Here they really want you out of the hospital asap when you’ve given birth but I guess they’d be equally concerned for the elderly to get infections from the hospital. But I guess they have a system for that too.

  • Yes, thank you, Olga. what is so noticeable about your experiences is the way the system integrates the various health care providers — none of the midwives are outside the national licensing/educational system and conform to standardized policies. This is almost the opposite of so much of US midwifery (I almost wrote “pseudo-midwifery”) where the homebirth midwives seem quite paranoid and or hostile to the medical establishment.

    • That is precisely the point- everyone has their very clear obligations and things that they’re allowed to do.I have interviewed a midwife and she said that she didn’t even notice any turf wars here, BUT midwives may be reluctant to transfer becasue they lose money- they’re paid in installments for each part of the pregnancy and birth. They are very powerful here and may not transfer where they should have to “show who’s in command”.

  • Renee

    The part about pain relief is really crappy. It seems like they are set up for NCN, anything else deviates from their plan.

    (Every time I read about services in other developed nations, I get more irritated with the USA. The in home care sounds great. I am sure there is also maternity leave, and assistance so families don’t go homeless. I am sure this is evil socialism, but I wish I lived in a nation that gave a crap about its people, and families, instead of just spouting platitudes.)

    • Jessica S.

      Yes! Less money on destructive things like militarism and more spending on life-building things like education, health services, and services for those in need. I’m with you!

      • AmyP

        But less pain relief and less possibility of maternal request c-section.

    • The pain relief part really sucks and I know many expats who drove back to their home countries so they wouldn’t have to give birth here. Yes there is maternity leave (although it is “only” like maybe 12 or 16 weeks) and insurance covers everything about the birth- but not for example if you stay too long in the hospital with a healthy newborn etc.

      • Having said all that the Netherlands are a very family-friendly country and I often see families with 3 children cycling around. It seems when you’re pregnant and giving birth, you’re not paid a lot of attention to but once you’ve given birth, you’re a princess.

    • ModerneTheophanu

      The pain relief issue is my biggest issue with midwifery centered care. It seems that if women have access to one, then they have restricted access to the other. For example, I watched an episode of the UK version of “One Born Every Minute” and a woman was crying out for pain relief and an epidural, and the midwives were telling her she couldn’t get it even though she was in the hospital. If someone wants pain relief, they should be able to get it. We wouldn’t dream of denying someone pain relief for dental work or setting a broken arm, so why is pain relief denied or restricted during birth? I love CNMs and wish I could see the CNMs at my OB office (all high risk patients see the OBs only), but it seems that in a lot of places, the midwifery model means that pain relief apart from gas & air is out of the question.

  • hurricanewarningdc

    Very interesting post. Thanks for sharing that!

    • Thank you so much! I am glad you thought my story was interesting.

  • Jocelyn

    Thank you for sharing your experiences, Olga!