Knowing local medical standards and host-country employment laws, plus having proper insurance, are among the things pregnant women living abroad should do, finds Rob Hyde.

• Maternity benefits in the Netherlands
• First-hand accounts of giving birth abroad
• What women should watch out for
• What EU law says about maternity coverage

Having a baby can be stressful and complex as it is, but when the whole experience takes place thousands of miles from home, it can be more difficult to ensure that all runs smoothly, before, during and after.

Far from friends and family, it is essential for expat women to know that their host country's medical system is up to scratch, that they will get financial support during the baby's infancy - and whether they will be left with a job to walk back to.

Netherlands-based lawyer and expat expert Patrick Rovers says that although the Dutch system is not perfect, expat women could do far worse than opting to have their baby in the Netherlands.

"Over here you find that 100 percent of a woman's income is paid when she is with child, when she leaves work to have the baby and when she takes time off to recover afterwards. The mother cannot be sacked during this 16-week period, and whatever an employer may think he can get away with or even try to, at the end of the day he can just stand on his head because sacking a pregnant lady cannot ever be the basis for a justified sacking."

The Netherlands has generous benefits for new father as well, points out Rovers. "Under current Dutch law, it is possible for both mother and father to take 13 weeks off to look after children under 8 years old, providing they have worked full time. However, these parents do not generally get full pay during this time, although for public servants about 75 percent is paid."

Under the Dutch system, an employer pays various contributions to an employee contribution scheme, which includes sickness insurance packages, and in the Netherlands, pregnancy falls under this sickness package. If you use the paternity leave, then officially you are regarded as 'sick' and the social insurance agencies then arrange to pay your salary.

While these general laws are applicable for everybody living and working in the Netherlands, expat workers, providing they are working under a Dutch contract and within the Dutch system, also stand to benefit from central employment agreements (CAOs) a special arrangement operated within various sectors of industry such as travel or machinery, and which allocate certain amounts of time and pay for parental leave.

Patrick Rovers says he regards the Dutch system as fairly easy for expats to understand and use, and most employers are quite aware of the situation and lenient about giving their workers a break.

"I know that Scandinavian countries grant lots more time to mothers and pay for them all the way through, and that some US nationals are more happy and comfortable with their own system," he says. "But most women are not allowed to fly after the eighth month of pregnancy, so they opt to stay in the Netherlands. Many Indian women opt to have their child here even if they could return home, as standards are far better here."

Dorota Sulek, originally from Poland, is currently living in the Netherlands with her husband who works for Phillips on an expat contract from the US, where they lived for 10 years. She agrees that the experience of giving birth in The Netherlands was surprisingly problem-free, despite being an expat.

"I would not want to have given birth in Poland, the health care sector is in trouble over there. I had my second child in Holland and it was a good, even pleasant experience, everything went fine with no medical problems, and although I didn't expect much, I was treated well all the way through and it was very convenient that everyone speaks English."

Sulek was satisfied with the coverage of her private insurance. "It worked out really well. I was out of hospital in no time, and turned down the offer of 40 hours' help from a state nanny, and instead could pocket the money."

In fact, Sulek says she had a better experience in the Netherlands than in the US. "There I only got eight weeks off and a fraction of the maternity leave provided here if you are working."

New Zealand expat Denise Ramstein also praises the Netherlands for its treatment of pregnant women.

Though having opted to retire instead of taking maternity leave, Ramstein says she was impressed with the level of support offered to her when she worked as an operational assistant for Phillips Media Design Group.

"I was 41 at the time and had only been at the company one week when I fell pregnant, and although I felt very awkward about it, they offered me a contract and a maternity package, and tried to talk me into taking time off and getting paid for it. They were very good about everything.

"However, as I was starting at 8am and would not come home till 6 or 7 at night, and child care does not go on for that long, I would have had trouble fulfilling both jobs - being a mother and also a worker."

Ramstein says nothing changes the fact that expats are ultimately at a disadvantage because at home, friends and family make up a strong support network of people to turn to for help and comfort.

"The Netherlands authorities were good in that they did supply a lot of literature; although most of it was in Dutch. The organisation for vaccinations did keep a close eye on me and even gave me a book in English, but it's still not the same," she explains.

Ramstein says another unavoidable fact is that medical practices in the host country are likely to differ, at least to some degree, from methods one may be used to at home.

"I was lucky because I had a very simple and easy birth, but had I wanted a specialist, something readily available in New Zealand, I could not have had one - I was just told that the midwives were the specialists."

She also notes the difference in attitude towards hospital births. "Had I been younger, the doctors would not have had me in hospital. They tend to encourage home births and you are an exception if go to hospital - it's very much the Dutch way."

But sticking with native hospital methods is not a must for all pregnant women. Julia Rutherford-Bate is a project manager at UK-based educational software provider, Actis, and has been pregnant for eight weeks.

Her husband spends the majority of the week in Düsseldorf working for car parts supplier Krupp, and the question of moving to Germany is constantly being raised. However, since becoming pregnant, Rutherford-Bate says she is not keen to move to Germany, although her chief concern is not the different health system.

"I would prefer to live in France where I speak the language and love the culture, whereas I speak no German and feel that it would be hard to live in Germany. However, I've got no problems about using the hospitals and medical facilities over there."

Rutherford-Bates is also more concerned about distance from family. "It means the grandparents might not have the contact with the child that they would like to, and that would be something very sad."

But other women remain far more cautious about the prospect of having a child abroad - and substantial evidence exists to back up such fears. Former expat Joanna Parfitt is the editor of UK-based Women Abroad magazine, and while working overseas, she was fired simply for being pregnant.

"It was horrible," says Parfitt. "I was working in Dubai 10 years for a British recruitment agency, and me and my assistant both fell pregnant and were sacked. The company used this as a way to get rid of us because it was not happy that we were earning lots of money and that they were only getting 20 percent of this."

According to Parfitt, the worst thing about the ordeal was that the company was perfectly within its rights because, although a British company, it was operating in the United Arab Emirates, which did not recognise maternity leave.

Although not all countries might be as harsh when it comes to pregnant women, Parfitt maintains that expat women would do well to be as thorough as possible in their research of a particular country before moving abroad to work and possibly becoming pregnant.

"I would say just make sure that you know what the law is, and don't just blindly think that because your company is run by people of your home country, that they will operate on the system that guarantees you maternity rights."

As a guarantee that expat workers will not lose sickness insurance coverage when changing employment and moving to another state in some countries, under EU law, one is entitled to sickness benefits after six months of insurance.

EU provisions ensure that a worker who had to interrupt previous insurance when moving to that state will be entitled to sickness benefits from the beginning of the insurance. The two major categories of benefits that exist, however, in all countries belonging to the EU or the European Economic Area are "benefits in cash" and "benefits in kind".

According to material published on the EU website, sickness benefits (including maternity) in cash are "benefits normally intended to replace income (wages, salaries) which is lost because of sickness. In some countries, national legislation provides that wages will continue to be paid for a number of days or weeks after the commencement of the incapacity for work; according to the case-law of the European Court of Justice, these payments are also considered as sickness benefits in cash".

As a general rule, sickness benefits in cash are always paid according to the legislation of the country where you are insured, regardless of which country you reside or stay in. Sickness benefits apply to all categories of persons and to all situations: frontier workers, seasonal workers, posted workers, pensioners or family members.

"Benefits in kind" comprise medical and dental care, medicines and hospitalisation as well as direct payments intended to reimburse the costs of these.

However, the EU stresses that these apparent benefits might not necessarily be that beneficial to expat workers, saying "the doctors and institutions concerned cannot possibly know the details of the legislations of 18 different countries; therefore, they always apply the legislation of their own country, even if the person concerned is insured in another country."

November 2001