(Disclaimer: this is the experience of one woman (me), and is by no means a comprehensive guide to Dutch prenatal care. So keep in mind that this blog is more experiential than a how-to.)
When people ask me, “How is the care different?” or “It’s way better, right?” I have a hard time answering. Estella was my first and only experience with prenatal care, so I have no previous stateside experience. I know that about 12.5 percent of our salaries go toward healthcare for our family.
Here are the main differences between US and Dutch healthcare:
The Netherlands is based upon a social-state system. The US is/was based upon a private-business system. What this means for the Netherlands is that the government and social care (including health) runs on a big cogwheel. The cogwheel has been carefully and brilliantly constructed to benefit the majority. Once the cogwheel starts in motion it is impossible to stop. So for the vast majority the healthcare works very well. For the ones who have extreme situations, not so much. But those extreme situations are rare.
In the Dutch system, there isn’t the plethora of choices to create-you-own-birth-experience: midwife, doula, hospital, home, birthing center, OB/GYN, or a selective combination. And you weren’t paying for those combinations. The message is, “Let us help you discover how our system works.” I took a step on the cogwheel and it worked well for me, and I’m thankful.
The Netherlands has a ‘treatment’ vs. ‘preventative’ emphasis, which pretty much means a ‘suck-it-up’ mentality. There aren’t urgent cares on every corner; the huisarts (general practitioners) are slower to prescribe antibiotics. There’s more a sense that, here, you get sick and you deal with it. Cup of tea, liquids, some sleep. If it’s not life threatening, soldier on. I sense that it’s really seen as bad taste to talk too much about how sick you feel. This mentality relates to pregnancy in that pregnancy isn’t seen as something to be overly excited about, but a natural part of life.
Midwives here are respected health professionals, much as we would value OB/GYN practitioners in the States. The OB/GYN doctors here are only in hospitals, and they only deal with high risk pregnancies, overdue pregnancies (here that’s 43 weeks or more), multiples, or Keizersnee (C-Sections).
When Frans and I found out I was pregnant, we called the verloskundige praktijk (midwives’ practice) and were told to book an appointment after eight weeks. The practice, comprised of about twelve midwives divided into two separate teams “Red” and “Yellow”, assigned us to the Yellow team. We met with one of the six midwives and talked over our options. She asked us detailed questions from our religious beliefs to our relationship status and documented it. Two weeks after that, we had an appointment at a separate echo technician’s office to check how far I was. To our surprise, they asserted that we were about 12 weeks along. I still wonder about that until this day. Estella was ‘late’ but arrived eleven days after her due date at 6 lbs., 13 oz. She was little.
We had a series of appointments that got closer together as the time went on, and on each appointment Estella’s heartbeat was checked and my belly palpitated. That was it. We were talked through our options, if I was feeling her move, etc. but there weren’t tests done or blood drawn. We had the choice early on to test for deformities (Down Syndrome, etc.) that we would have had to pay for, but we opted out of that test and decided to just take whomever came along.
Each appointment the midwives listened to my symptoms, responded with ‘well that sounds normal,’ but they did have a 24-hour hotline we could call if we were panicked about lack of movement, etc. They never did tests because, based upon my reported symptoms, they felt confident enough to rule out gestational diabetes, etc. I think this also seems different in the States. It seems like more and more tests are given ‘just to be sure’ or ‘to rule this or that out.’ Just a different mentality. We had a second echo at 20 weeks and that was it. We were given pictures on a USB to ooh and aahh over at home.
We did have a few scares later in the pregnancy. We traveled from Amsterdam to Florida and back when I was 28 and 31 weeks along. You’re not supposed to fly after 28 (recommended), but I had a ‘fit to fly’ from our midwife team and was good to go. On the ten hour flight to Florida, I drank tons of water and got up to walk every hour or so. But I noticed that it felt like ‘the baby didn’t like it.’ And looking back at pictures I looked very swollen in Florida.
A week before our return trip, I decided to go to the hospital in Florida because I felt like amniotic fluid was leaking. I had been very uncomfortable for about a week and a half, but just chalked it up to third trimester aches and pains. I got to the hospital and they immediately plugged me in and did all kinds of tests. “Whoa,” said the technician. “You’re in early labor. See? You’re having contractions.” They kept me in for a series of tests, did an ultrasound to check my fluid, and ended up giving me a shot designed to stop the contractions.
I felt much better after a few days, less uncomfortable. A week later, I flew back to Amsterdam, afraid the flight would trigger it all again. When my midwife team heard the story, they looked a little annoyed. “A shot?” they asked in disbelief. “Jaaaahh. That’s not really early labor…” But that was the end of my early contractions, or whatever they were, and instead of two months early, Estella was born 11 days late.
Frans and I paid for and took a private birthing class (I wanted one in English.) She talked us through the pregnancy and birth, gave us some visualization and relaxation tips, some breathing practices, but I think we mostly took it to calm us both down. I was nervous that something would go wrong during delivery, and at one point I told her. “Well,” she said. “That is unlikely, but if it happens it happens and it’s just your lot in life.” None of this was meant unkindly, but was meant as a “Kom op!” and get in there, you’ll be fine, stop worrying. Again, different mentality.
The whole pregnancy the whole question for me was, “Will I give birth at home or in the hospital?” A birthing center was an option, but although it was luxurious and beautiful like a birth B&B, it was both expensive and in city apartments, which meant getting down to an ambulance in case of an emergency would have been near impossible with those steep staircases. Here in Amsterdam, if a home birth becomes an emergency and the woman has to be taken to the hospital, many times ambulances have to raise a ladder up to the window and lower her out of the window. We live catty corner from an elementary school, so I kept imagining this educational experience for the kids.
The idea of giving birth in our home appealed to me because of the calm, familiar atmosphere. I also wanted to try to go totally without meds, and I was afraid that I would be tempted in a hospital to ask for the epidural. On the other hand, everybody kept asking “what if something goes wrong?” and sometimes even adding, “I could never forgive myself.” So I had that playing in my brain too. So, in the end Frans and I decided to leave it open. I packed my bags and made banana bread. The bags were for a trip to the hospital if I felt like in the moment it was a safer, realer option, and the banana bread was for the midwife if it happened at home.
Let’s just say that the banana bread was a good idea.