Giving birth in the Netherlands: an expat’s story


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.