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.

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