Wed. May 29th, 2024
Advertisement

When we first starting thinking about starting a family in the Netherlands, we weren’t entirely sure what to expect.

All first-time parents go through a massive learning curve. Having a baby in a foreign country where you don’t speak the language adds even more complexity.

Now that I’m on the other side, I can look back on the whole experience and say that having a baby in the Netherlands was a really great experience. And while I’m not able to say definitively whether it was better than it would have been in the United States, what I can say for sure is that it’s different.

I’ve gotten a lot of questions from family and friends on what it’s like to have a baby here, so I thought I’d share more about my experience for others that may be interested.

What I’ll cover:

  • Mentality difference: “natural” vs “medical”
  • Prenatal care
    • Midwifery
    • Prenatal testing and checkups
  • Labor and delivery
    • Home births, hospital births, and birthing centers
    • Induction
    • Medical pain management
    • Hospital stays
    • The cost of having a baby
  • Postnatal care for mom & baby
    • The Kraamzorg system
    • Baby checkups & the Consultaziebeaureau
    • Vaccinations
  • Parental leave
    • Maternity and paternity leave
    • Papadag and Mamadag
  • Traditions

Mentality difference: “natural” vs “medical”

Before we dive deep into the differences between the Dutch and American approach to pregnancy, birth, and beyond, it’s helpful to understand how the mentality between the two cultures differs.

The Dutch think of pregnancy and childbirth as natural processes that require little intervention, whereas the American mentality views them more as medical conditions that warrant specialized treatment.

Now, these are of course generalizations — not everyone in the Netherlands is having a home birth, just like not everyone in the US opts for an epidural — but understanding this fundamental difference can help explain a lot of the key differences in approach that you’ll read in the following sections.

Prenatal care

Midwifery

The first and most obvious difference between the United States in the Netherlands is that typically all prenatal care happens with your midwife, not with an obstetrician.

The Netherlands has a sort of tiered medical system with more “generalist” providers serving as the first point of contact for any non-life-threatening medical issues. The only way you’ll see a specialist (or in the case of pregnancy, an OB) is if they refer you, and most specialist appointments will mean a trip to the hospital.

So for the majority of women who have an uncomplicated pregnancy, they’ll meet only with their midwife for all prenatal checkups.

Most practices operate as a team of several midwives. Throughout your pregnancy, you meet with each midwife at different checkups so that you have a chance to get to know everyone. Then when the big day arrives, whichever midwife is “on call” that day will be the one to support you through labor and delivery.

If you’re having a home birth, they’ll be your primary support from start to finish. If you’re heading into a hospital, they’ll likely join you to the hospital and help you get settled in before handing things over to the medical team.

Prenatal testing and checkups

Another key difference between the Dutch and American healthcare systems is the approach to preventative medicine. Things like annual physicals and checkups with an OBGYN are not routine here.

A similar approach applies to pregnancy. Only basic blood tests and physical examinations are done, and only if something falls outside of the normal range or if you have a family history of certain complications will further tests be arranged.

In the US, glucose tests (for gestational diabetes) and GBS screening (for Group B streptococcus) are considered standard and often performed regardless of any increased risk. These are only administered in the Netherlands if there are certain risk factors that justify doing so.

Similar to the US, you can expect routine checkups with the midwife practice throughout pregnancy at set intervals that increase as the pregnancy progresses.

The first appointment is typically toward the end of the first trimester. From there, checkups are spaced four weeks apart for the first half of the pregnancy and eventually become more frequent as the due date approaches. By the end of the third trimester, you’ll visit your midwife on a biweekly or even weekly basis.

Labor and delivery

Advertisement

Home births, hospital births, and birthing centers

The Netherlands has the highest rate of home births of any Western country. In the 1970s, nearly 75% of babies were born at home. These days, more women are opting for a hospital birth, but home births are still much more common than in the US.

In the Netherlands:

  • About 30% of babies are born at home (vs 1% in the US)
  • About 60% are born in hospitals (vs 98% in the US)
  • About 10% are born in birthing centers (vs <1% in the US)

In the weeks leading up to your due date, you’re asked to put together a birth plan and share it with your midwife. As a part of this plan, you can indicate whether you would like a hospital birth, and if so, what hospitals are preferred.

For those who prefer to give birth in a hospital or birthing center, there is no guarantee that there will be a room available for you at the moment you go into labor (unless, of course, it is a medical emergency). There is no such thing as “reserving” a hospital room in advance, so rooms are occupied on a first-come-first-served basis.

Once labor has sufficiently progressed, your midwife will come to your home to check if you are dilated enough to be admitted to the hospital. Only then will they start calling around to your list of hospitals in order of preference to see which one has a room available. In non-COVID times, you’re likely to find a spot at one of your top three hospitals.

I happened to go into labor at the very peak of Covid cases in the Netherlands. Due to staffing shortages, none of the hospitals in the Amsterdam metropolitan area had a room available. Luckily my midwife was able to find a space for me at a hospital in a neighboring town, but that meant driving for 45 minutes while having contractions five minutes apart. Not my favorite road trip ever.

Induction

Medical interventions in general are less common here, and one of the most notable differences is with inductions.

In the US, an induction date will likely be scheduled for you once you near your due date. In some cases, elective inductions may be scheduled as early as 39 weeks (one week before the due date).

In the Netherlands, your midwife will start talking to you about induction from the 41-week mark. At one week beyond your due date, an induction is still optional. If you make it a full two weeks beyond your due date, it becomes mandatory.

I went into labor five days after my due date, which according to my midwife is typical for first-time mothers in the Netherlands. My midwife did hint that if I was having a difficult time waiting and wanted to induce sooner, I could have one a bit “early” (before 41 weeks), but she certainly wasn’t recommending it.

Medical pain management

Women in the Netherlands have the same options as women in the US when it comes to medical pain relief. Epidurals, Pethidine (a less potent version of morphine), Remifentanil, and laughing gas are all available — well I should say they’re technically available… more on that later.

Where things differ is in the number of women that choose medical pain relief. Take, for example, that stats regarding epidurals: in the US, 61% of women have an epidural. In the Netherlands, that number is only 22%.

I think this again speaks to a mentality difference between the two cultures. For the Dutch, pain is more commonly seen as a natural part of labor.

This mentality doesn’t just apply to childbirth either. There’s an ongoing joke among expats about how Paracetamol (the European version of Tylenol) is prescribed as a cure-all for just about anything. Even when I fractured a bone in my face, I was given only Paracetamol to help with the pain. What fun!

I took a childbirth class while pregnant, and a large part of this was focused on the concept that we should expect childbirth to hurt and that pain is a necessary part of the feedback loop that happens during labor (pain causes oxytocin to be released, which causes a contraction that in turn causes more pain… and so on).

Another reason for this difference is related to the previous section regarding home vs hospital births. Only hospitals can administer the full range of medical pain relief options, and only some birthing centers can give laughing gas. And for those giving birth at home, over-the-counter pain medication is all you have. We meet again, Paracetemol.

Availability is also a component. For women giving birth in the hospital that request an epidural, there is no guarantee that you will be able to get one.

Hospitals in the Netherlands typically have at most one anaesthetist at any given time, and that person is servicing all patients at the hospital, not just the labor ward (as is typically the case in the US). Naturally, this means that other patients that require anesthesia for surgeries or medical emergencies are always prioritized over women in labor.

Advertisement

Smaller hospitals may also only administer epidurals during normal office hours, so if you show up to the hospital in the middle of the night, it may not be an option for you.

I initially planned for an epidural but mentally prepared myself that I may not get one. And sure enough, I ended up doing without.

When I arrived at the hospital, I was dilated around 7cm. The doctor said that she could request an epidural still at that point, but given how far along I was (and without knowing how long it would take for the anaesthetist to get there), I opted for Pethidine instead, which could be administered on the spot.

Hospital stays

Now, you may want to sit down for this one.

I was in the car heading back home just three hours after giving birth. That’s right, three hours.

It’s possible that you’ll be sent home in as little as two hours even. Our daughter’s temperature was a little low after she was born, so they kept her the extra hour to get it back up to a normal range.

What this looks like in practice:

  1. Baby is born
  2. Normal post-birth activities take place (cord cutting, measurements, birthing the placenta, etc.)
  3. Baby and parents are left alone for their “golden hour” of bonding time
  4. Nurse comes back in, helps mom into the shower, and gets the baby dressed
  5. Official birth records are handed over to the new parents as they’re ushered out of the hospital

All in all, we were at the hospital for around 5 1/2 hours. We arrived at 5:30pm, our daughter was born at 8pm, and by 11pm we were driving back to Amsterdam.

Luckily, you’re not entirely on your own once you get home. The Netherlands has a wonderful system for providing support to parents and baby in the first days after leaving the hospital, which I’ll cover later on.

The cost of having a baby

I’ve learned that a surefire way to shock your European colleagues is to tell them what it costs to give birth in the US.

On average, parents have to pay roughly $3,000 to have a baby in the US (with insurance, mind you), and that number can be much higher for non-standard births. Things like cesarians, inductions, epidurals, and extended hospital stays are not uncommon and can really increase your out-of-pocket expenses.

We have pretty basic insurance, and everything was completely covered by insurance.

This includes everything from the prenatal checkups and ultrasounds to the birth itself. The only expense we had was one extra “non-medical” ultrasound that we paid for ourselves to see the gender of the baby at 15 weeks, and that cost us a whopping €50.

Postnatal care for mom & baby

The Kraamzorg system

So you know how I mentioned women spend typically just two hours at the hospital after giving birth? Well this is all made possible thanks to a unique system in the Netherlands where a postnatal maternity nurse (called a “kraamzorg”) comes to your home every day for the first 10 days after your child is born.

The kraamzorg’s main purpose is to perform basic wellness checks on mama and baby and support the new parents by teaching them how to take care of their new roommate (e.g. how to give a baby a bath, advice on breastfeeding). The midwife also drops in over the same timeframe to check on how mom is doing and coordinates closely with the kraamzorg if there are any concerns.

Our kraamzorg Jill of Jillz Kraamzorg was an absolute godsend.

In addition to all of the above, she helped make sure that my husband and I were also taking care of our own needs. She’d watch our daughter while we got some sleep and would even cook meals and do some household chores to alleviate the mental and physical load during those first couple of weeks.

While people’s experiences and opinions do vary, I thought the kraamzorg system was absolutely brilliant.

Sure, it’s a bit jarring to get kicked out of the hospital so soon after giving birth, but it really is nice already being in your own space and adjusting to your new life from the comfort of home. And for expats that are thousands of miles from home, it’s nice to have that extra support while waiting for your family to fly over.

Our kraamzorg Jill with our daughter Luna

Baby checkups & the Consultaziebeaureau

Once the baby is born, the Consultaziebeaureau (aka “CB”) takes over with monitoring the health, development, and growth of your child for the first four years of their life. At the age of four, children start primary school and check-ups are then continued by the school’s doctor.

The CB administers all vaccines, takes height and weight measurements, and tracks developmental milestones. They’re also available to give advice and help parents with any behavioural, feeding, or sleep issues they face.

While they don’t treat any medical conditions, they can advise you on whether a problem your baby is having is worth speaking to a doctor about. If a doctor is needed, the baby sees the mother’s GP, who can then refer you to a specialist if needed (here a paediatrician is considered a specialist).

In the first few weeks after your baby is born, the CB sends nurses to your home to take measurements and perform routine tests (bloodwork, hearing, etc). Similar to the kraamzorg system, I love the emphasis on making things convenient for the parents in those first few weeks.

The first “real” appointment outside of the house comes at four weeks. You are assigned to a specific CB location based on where you live, so if you live in a city, you’re within walking distance. Ours is just a few blocks from our home.

Lastly, all measurements and a log of the baby’s vaccinations are recorded in a Growth Guide that you keep at home and bring with you to all of your appointments. The Growth Guide also includes a lot of recommendations and tips on what you can expect in the first few years of your child’s life.

Vaccinations

A lot of vaccinations are standard between the US and the Netherlands.

Within the first 14 months, babies in the Netherlands will receive vaccinations for:

  • DTaP = combined vaccination for Diphtheria, Tetanus, and Whooping Cough
  • IPV = Poliomyelitis
  • Hib = Haemophilus influenza type B
  • HBV = Hepatitis B
  • MMR = Measles, Mumps, Rubella
  • Men ACWY = Meningococcal ACWY
  • PCV = Pneumococcal vaccination

Check the official Rijks Vaccination Program website for more information.

Rotavirus, Varicella, and Hepatitis A are all standard vaccinations in the United States that are not included in the standard vaccination program in the Netherlands. Annual influenza vaccines are also not considered standard here (it’s the same for adults).

That said, you do have the option to request and pay for some additional vaccines through your GP, like the ones listed above.

Parental leave

Maternity and paternity leave

Let me start off by saying that the United States is absolutely horrendous when it comes to parental leave. The fact that mothers are not entitled to any compensation after having a child is mind-blowing. And certainly, in comparison to the US, the Netherlands is one hundred times better.

I won’t go into too much detail about the various parental leave schemes here, as it’s quite complicated, but to briefly summarize the main points (assuming both parents are working full-time):

  • Mothers get four months off, fully paid; typically one month before the baby is born and three months after
  • Fathers and partners get one week off, fully paid, within four weeks after the child is born; they also get an additional five weeks that must be used within the first six months and is paid up to 70% of their salary
  • Both parents are entitled to an additional 26 weeks of parental leave that’s unpaid and must be used before the child turns eight
  • As of August 2022, the first nine weeks of this additional parental leave are paid up to 70% of their salary so long as it is used before the child turns one

Check the official NL government website for the most up-to-date information regarding parental leave in the Netherlands.

Clearly from the American perspective this sounds like a pretty sweet deal, but in comparison to other European countries, the Netherlands actually ranks pretty low on the list of best places to have a baby (especially when it comes to paternity / partner leave).

Papadag and Mamadag

One thing that I really love is the Dutch concept of a papadag or mamadag (papa or mama day).

It’s common for parents with young children to use their 26 weeks of extended parental leave to take one day off a week. What’s really nice is that this is commonly done by both parents, not just the mother, and from my experience employers are very accommodating of parents that wish to switch to a four-day work week.

The major benefit of this arrangement is that both parents, not just the mother, learn how to take care of their child on their own. Long-term, this helps ensure childcare is more equally distributed and avoids the mother becoming the de facto primary carer and baby whisperer.

Traditions

Last but not least, there are a few nice (and quirky) traditions in the Netherlands related to having a baby that are worth sharing.

  • The first thing you’ll likely eat after having a baby is what’s called Beschuit met Muisjes, which translates to Little Mice on a Rusk. Mmmm… sounds delicious, doesn’t it? These are little pieces of dry toast that are covered in butter and topped with pink or blue chocolate-covered anise “sprinkles”. Why the anise, you say? The Dutch do love their liquorice, of course, but it’s also thought that anise helps with lactation.
  • Birth announcements are very common in the Netherlands. People also put storks in their window to signify to their neighbors that the baby has arrived.
  • After a baby is born, you’re essentially hosting an open house. Anyone is free to drop by unannounced to meet the baby. If you want to limit the timeframe to give yourselves some privacy, you can explicitly mention the times that visitors are not allowed in your birth announcement (e.g. “Mama and baby will be resting between 2 and 4pm”).

Source: https://thepostcard.me/

Advertisement

By Lala