Tuesday, November 13, 2007

Having a baby in Holland*

*apologies to our Dutch friends for treating this as an odd topic, but it's just different over here and people want to know

Since we've announced our pregnancy, I've heard questions and concerns from many of you about where we plan to have the baby and what the process is like in The Netherlands. From what I gather, most of you are apprehensive about (if not outright opposed to) our having the baby here versus back in the States, so I thought I'd lay it all out in a post for those who are interested in the hows and whys of birthing in Holland.

First off, yes, we plan to have the baby here. Bronovo hospital is a fairly new hospital in The Hague, and if it makes you feel good to know this, the royal family uses it for their births too (in fact, they celebrated the arrival of princess #3 earlier this year). The system here is set up for women with normal, healthy pregnancies (no obvious risks) to see midwives. Only those with obvious medical concerns see gynocologists during their pregnancies, but even then, their doctors are usually not present at deliveries; those deliveries are generally attended by whichever resident is on duty, with a specialized OB on call in case of emergency. Thankfully, I am in the former category. I had a great pregnancy with Ellie, and things are going very well this time around too. That means we see midwives. I use the plural on that, because we don't actually have a particular midwife we see. Bronovo has a midwifery practice right in the hospital, and there are seven midwives on staff. Appointments are set up with the goal of the pregnant woman seeing a different midwife each visit, so you can get to know each face and therefore not greet a total stranger while in labor (since you get whomever is on call that day/night; there's no picking favorites).

At the first visit to the midwife, I was asked if I preferred to have the birth at home or in hospital, and I went with option B. After all, who needs the mess? Since that first visit, I've been seen fairly infrequently (once every 4-6 weeks). The appointments rarely last more than 10 minutes. They take my blood pressure and measure my weight, and the midwife feels my belly and listens to the baby's heartbeat. That's it! We had an ultrasound at 10 weeks to determine due date (Feb 27) and another at 20 weeks to check organs, spine, etc. No more ultrasounds are expected. I had a blood test last week to check for gestational diabetes. No nasty sugary drink beforehand. No peeing in a cup each visit to the midwife to check sugars. The big key to birthing in Holland is their approach: pregnancy is not a medical condition. You are not sick; you are pregnant. This is a normal, healthy process for most women, and they strongly believe in being hands-off. This is actually something I really like, but this is also the scary part for most expats, particularly those who come from the US and are accustomed to birth plans and calling the shots as much as possible. I'm thinking specifically about pain medication, and how we Americans (and many other foreigners) clamour to get our hands on it.

Rumor has it that in the not-too-distant past, the Dutch system barred women from pain relief (specifically epidurals, which are common in the US). We have friends (who are not Dutch) who gave birth in Holland within the past few years, and they report being denied any form of pain medication, even when repeatedly requested during labor. While I personally am all for going with a natural process, I am a fan of knowing there is help if I need it. The idea that they would tell me I couldn't have it just because of a cultural boundary made me a little nervous too...initially. Since then, my fears have been put to rest. At least in The Hague, the expectations have changed. There are so many international people here that the cultural belief in being hands-off and the expat desire for pain assistance have found some common ground. Although the midwives prefer for women to do their best on their own with the labor, pain medication is now available if needed. Other more mild forms of assistance are tried before epidurals, which (though available) transform the birth into a very medical process requiring catheters, IV drips, monitoring, etc. as well as transfer into the hands of a doctor (no longer birthing with a midwife).

Last night, I attended the first-ever in English presentation of "Birthing at Bronovo", for which there was an apparent need given the size of the audience. I swear, I've never lived in such a pregnant place as The Hague. There are bellies everywhere! But I digress...
The presentation was given by a midwife, a doctor, and an obstetrical nurse. They combined efforts to let everyone know what to expect for the birth and labor process, as well as the time after the birth. It was a very useful evening, particularly when (like me) you just like knowing what to expect.

This leads me to another point that has worried some of you: going home soon after the birth. If all goes well, it is common here that mommies and new babies go home within a few hours. "WHAT??!!!" you say. Actually, they have thought this through beautifully. When you have a baby in the US, you are in the hospital for at least 24 hours afterwards, during which time nurses come in and bug you miserable every few hours taking your temperature and blood pressure and generally keeping you from what little sleep your newborn allows. In my case with Ellie, add to that a FREEZING COLD room with no temperature controls, a shared room where papa couldn't stay, and fights with the nursery staff about breastfeeding and no bottles or pacifiers. It was crazy. In Holland, they believe you will recover best at home, so they send a nurse there. This nurse is a "kraamzorg", and she comes to your home (often is there when you arrive from the hospital) to care for the mother and newborn for a few hours every day of the first week. She will often help with household chores as well. Some even take care of grocery shopping and meals! Of course, the level of service is up to you and your insurance company. We're just going for maternal and baby care. The kraamzorg we have works independently of an agency and she works almost exclusively with expats. The upside to this is the fact that she speaks English, knows what people tend to expect, and also knows how to allay fears or concerns following the Dutch system. In addition to the kraamzorg, a midwife will check in on mama's recovery three or four times to make sure all is well.

Just as in the US, there is a follow-up appointment at six weeks to make sure everything is okay. You can always call and ask questions (before or after the birth), and you can come in to see them if there are any big concerns. All in all, the system seems excellent. Perhaps this is why Holland has a stellar health record for moms and babies (higher than the US, I might add). We feel confident about staying here for baby #2, and we'll be sure to let you know how it goes! Of course, you'll have to give us a few more months for that posting.


Anonymous said...

Thanks so much for sharing how things work in Holland! I think it's really cool to see how different the approach is to pregnancy and birth over there, and from what you described it sounds like they have a pretty good system. It sounds like it will be a good process and a good experience. I can't wait to see how things go...although I guess I can wait the next few months to find out :)


Gail said...

That's incredible. The start of this entry had me confused - it never occurred to me that perhaps I should be concerned about you giving birth in The Hague. I just learned a whole lot about something that I had no idea I knew nothing about - how about that?! I think that your approach to this pregnancy is healthy and awesome - and it seems that Holland is right in line with you. I must say, however, that if you were trying to quell the fears of western-medicine dependent and loving folks, I'm not sure this entry is the thing to do it! People will still see "NO DOCTOR" and "NO BIG FANCY MACHINES" and "NO EXPENSIVE EQUIPMENT" and, the most foreign of all, "MIDWIVES."