Travelling the road to parenthood is a trip full of excitement and anticipation. Taking this journey in The Netherlands is a unique experience but a potential culture shock for unprepared expatriates.

So, what does the Dutch maternity system hold in store? The keyword here is natural. The viewpoint in The Netherlands is that childbirth is not a medical condition and pregnant women should not be treated as patients.  As a result pain relief is not encouraged and home births are all the rage.

Choosing a midwife
The first priority is to find a midwife. The role of the doctor or gynaecologist in a normal pregnancy in The Netherlands is minor and in most cases not involved at all. This is slightly different to the UK, and a complete contrast to the United States.  
Choosing a midwife is often a tough task for an expatriate but three reliable search tools are at your disposal;
1.    A list of local midwives from your GP
2.    Word of mouth
3.    The Royal Dutch Organisation of Midwives (KNOV) website. Simply enter your home town (Voer uw woonplaats in) to find a midwife near you.
Your first appointment will be any time from week six of your pregnancy, but more usually around ten weeks. This initial contact is a good time to let your midwife know how you visualise the labour and birth process. It is reassuring to know that you can always change your midwife during your pregnancy if it does not click, or you feel that your birth plan cannot be carried out as you want.

There’s no place like home
You will be asked where you want to deliver your baby. With 30 percent of all births taking place at home The Netherlands boasts the highest rate of home births in the world. In Britain home births account for 2 percent of total births, in Belgium this figure is closer to 1 percent. Similarly 99 percent of births in the United States take place in a hospital environment.

Johanna Pearce delivered her son in England and recalls ‘We never planned for a home birth and it wasn’t encouraged as it was my first pregnancy.”  This is no reason to dismiss a home birth in The Netherlands.

British mother Helen Collin gave birth across the border in Belgium. She explains “Home births are uncommon in Belgium and it wasn’t discussed with the doctor. This was no problem as I wanted the baby in hospital anyway.” Helen is not unique; according to the midwives at EMBÉ in Zoetermeer it is unusual for an expat to want a home delivery.

Naturally no risks are taken and if there are prevailing medical reasons then a home birth will not be considered. Joan Da Silva, an Irish expatriate living in Holland, explained that due to a weak cervix a home birth was not an option. Interestingly enough, unless a hospital birth is necessary for medical reasons health insurance policies may not cover the entire bill so check with your insurance provider.

If you are one of the atypical expatriates opting for a home birth then you will receive a kraampakket from your health insurer. Be warned. For the faint-hearted this can be quite an eye-opening box of goodies landing on your doorstep. It contains all the items you need to prepare for a homebirth.

For a hospital delivery you need to register directly with the hospital five months into your pregnancy. If you are unsure about where to deliver it is a good idea to register with the hospital anyway. Most hospitals organise information evenings, including a tour of the maternity unit, which may help you make a decision.
Wherever you plan to deliver you will need to hit the shops, armed with a checklist from your midwife, for postnatal care supplies. Something guaranteed to raise questions, if not smiles back home are the metal bed raisers (or beer-crates) you need to hire so that the height of your bed complies with health and safety regulations for maternity professionals.

Drugs or no drugs, that is the question
In neighbouring Belgium 60 percent of women use pain relief, in the United Kingdom this figure is closer to a third. In the Netherlands this is just 10 percent. John Furlong, a Brit living in Madrid, explained that his wife received pain relief 15 hours after labour began. ‘’She had an epidural which nearly all Spaniards use. The medical staff was very pro-epidural.” In Holland this is a stance you are more unlikely to come across.

The issue of pain relief is generally not addressed as a matter of course and you should bring it to your midwife’s attention at the first meeting if it is part of your birthing plan. Pain relief is ruled out at a home birth as midwives are not qualified to administer anaesthetics.

Although births are becoming more ‘medicalised’ two out of three hospitals in the Netherlands have no anaesthetist available after office hours, according to Prof. Jan Nijhuis (Vereniging van Gynaecologen - Association of Gynaecologists). A report into maternity care outside normal hours by Gerard Visser (Universitair Medisch Centrum Utrecht) and Eric Steegers (Erasmus Medisch Centrum in Rotterdam) has led to the current maternity system being hotly debated in Dutch society. There may be changes afoot, but as it stands pain relief should not be taken for granted.

Prenatal classes
Instead, the emphasis is placed on natural methods of pain management such as those taught in prenatal yoga courses. According to Diane Hargraves, an experienced yoga teacher, “Midwives recommend yoga to complete beginners as well as women who have practised before as there are so many benefits to be gained, and they have seen the proof in the delivery unit.  Relaxation and breathing techniques can easily be learned in a pregnancy yoga class.’’

Help! I’m pregnant in Holland

•    Make sure you know what your medical insurance covers you for so there are no nasty surprises at a time when the less stress the better!

•    Register with a midwife early, usually before the seventh week. Talk to people to get recommendations and make sure English is not a problem if your Dutch is a little patchy.

•    Register yourself with a ‘kraamzorg’ agency, preferably before the 12th week of pregnancy. Your midwife can direct you to organisations they partner with and your health insurance provider must be contacted to ensure your chosen kraamzorg is approved by them.

•    Decide where you want your baby delivered – the Dutch are big believers in home births so make it clear if you want a hospital birth.

•    Pain relief? The rate of epidural use in the Netherlands is low and there is an absence of anaesthetists available out of ‘normal’ hours so do your homework to find out which hospitals can honour your request for pain relief.

•    Choose a prenatal group carefully. Language is a first consideration. How much do you want your partner involved? Many Dutch groups concentrate on breathing techniques for natural births.

Whilst expecting her first baby Danijela Furcic attended a prenatal yoga group, “At the time I thought it was all funny and not too helpful, but when contractions started I was really grateful for the breathing advice received at these classes!”
Diane Hargraves further explains, “The focus of a prenatal yoga class is developing awareness through detachment. It brings the realisation that no matter what is going on around you during labour, you can still keep your focus and move ahead with, what is after all, a natural process.’’

If your Dutch is up to scratch 'Samen Bevallen' is an alternative to pregnancy yoga. The course emphasises the partner’s role during labour and arms you both with breathing and massage techniques, as well as practical tips and information.
An alternative means of birth preparation is to engage a doula, a relatively new phenomena in The Netherlands but none the less one gaining popularity. A doula is present throughout labour and the birth to offer support and guide you.

The national site for doulas has a directory as well as an overview in English.
Of course any prenatal course you attend provides an opportunity to meet other expectant mothers or couples but the class you choose, and how helpful it turns out to be once labour starts, does depend on your knowledge of the Dutch language. A young mother from Montenegro shared that she attended prenatal yoga, “It didn’t help much, because I didn’t understand everything well in Dutch.” For prenatal courses in English, Access is a good organisation to contact.

Postnatal care
Most probably the main merit of giving birth in The Netherlands lies in the postnatal care. It is not unusual to be out of hospital a matter of hours after your baby is born.  

There is a logical explanation for the short post natal care in Dutch hospitals; kraamzorg. This is a maternity care assistant and the envy of many a woman outside of Holland. This type of maternity care is pretty much unique to The Netherlands. For at least a week after the birth professional help is on hand. During a home birth the maternity care assistant supports the midwife and after a hospital birth the maternity care assistant is on your doorstep within hours of leaving hospital. If your baby is born at night expect an overnight stay in hospital as the kraamzorg service is not available after hours.

Kraamzorg duties range from care for the new mother and infant, light household duties, guidance on breast feeding and baby care and looking after other family members (such as other children). For expatriates away from their support network this assistance can prove invaluable.

Of course you cannot control all the factors of a natural process but preparation, planning and research are key factors in ensuring there are no surprises during labour and the birth of your baby. Louise Silverton from the Royal College of Midwives in the UK states “All the evidence shows the more informed a woman is about labour, the less pain she will feel, especially where she is in a familiar environment with people she knows.”  The Dutch maternity system is certainly unique but forewarned is forearmed!

Useful links
KNOV – Find a midwife in your area
Access provides a range of child birth and baby course in English in The Hague and Amsterdam
Prenatal Yoga Teachers and information
GreatExpectations.nl offers courses in English to prepare for birth in The Hague
The Dutch Doula site has a page in English as well as a national directory
Parenting in Holland gives a good overview of pregnancy and birth in Holland, as well as information for caring for babies and toddlers
 Samen Bevallen offers pregnancy courses in Dutch with active participation of a partner
Thuiszorgwinkel  supplies items necessary for a home birth and post natal care (in Dutch)

Delft MaMa, for advice and courses on giving birth in the Netherlands for parents (to be) in Delft and the surrounding area.

Editor's note: Take a look at this article for some recommended pregnancy yoga teachers and prenatal classes in English.

 A-Z of pregnancy and birthing in Dutch
Bedverhogers – bed raisers (available from a Thuiszorgwinkel to hire and a health and safety requirement for a home birth and post natal care)
Bevalling – labour, giving birth
Bloedonderzoek – blood test
Borstvoeding – breastfeeding
Breken van de vliezen – waters breaking
Hydrofiel luiers – muslins
Kraampakket – items sent by medical insurer to prepare for a home birth and post natal care
Kraamverzorgster – maternity care assistant
Kraamzorg – maternity care
Kruiken – hot water bottles (metal)
Navelklem – umbilical cord clamp
Poliklinische bevalling – hospital birth
Thuisbevalling – home birth
Thuiszorgwinkel – a national network of shops selling and hiring items for the pregnancy, birth and post natal care
Uitgerekende datum – due date
Verloskundige – midwife
Vruchtwater – embryonic fluid
Weeën – contractions
Zwangerschap – pregnancy
Zwangerschapscursus – prenatal course
Zwangerschapsyoga – Prenatal yoga

Film: The business of giving birth

Photo credit: the photos used in this article (by Paulo Netto), are from the fim 'The business of giving birth' a documentary film about home-birthing by Abby Epstein, Executive Produced by Ricki Lake . Although you missed the benefit screening of this film in Amsterdam on 21 April, you can still purchase the DVD from the website given below.

Footage of women having babies punctuates the “The business of being born” Each experience is unique; all are equally beautiful and equally surprising.  Giving birth is clearly the most physically challenging event these women have ever gone through, but it is also the most emotionally rewarding.  Along the way, director Epstein conducts interviews with a number of obstetricians, experts and advocates about the history, culture and economics of childbirth. The film’s fundamental question: should most births be viewed as a natural life process, or should every delivery be treated as a potential medical emergency? As Epstein uncovers some surprising answers, her own pregnancy adds a personal dimension.
To see the trailer and for more information go to www.thebusinessofbeingborn.com

If you would like to discuss childbirth in the Netherlands you can pick up the thread 'Having my first baby in NL' on Expatica's community forums. If you haven't registered yet, you can do so here.

Amanda van Mulligen, British born, moved to The Netherlands in 2000 and runs The Writing Well, an English language writing and translation business. She is married to a Dutchman and has one son. Amanda writes about life as an expatriate in Holland as well as travel articles. For more information visit her website at www.TheWritingWell.eu