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You are here: Home Health & Fitness Healthcare Maternity matters: What to expect in the Netherlands
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21/03/2009Maternity matters: What to expect in the Netherlands

Maternity matters: What to expect in the Netherlands Amanda van Mulligen looks at some of the challenges and benefits for expatriates of the maternity system in the Netherlands and how it differs to other countries. The article includes useful links and an A-Z of pregnancy and birthing in Dutch.

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.

Business of being bornFor 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, Amsterdam and Rotterdam
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.

Business of giving birthFootage 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




28 reactions to this article

Ams posted: 2009-05-13 15:10:13

"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"- I doubt about this line. I just gave birth 2 months ago in the hosp but we did'nt arrange anything (we dont have to) in the hospital prior to the delivery. Unless you're scheduled for CS, than you have to arrange that. For normal delivery, your midwife will call the nearest hospital if your about 4-5cm dilation (ontsluiting). Our plan was to stay at home for my early labor and go to the hosp when it's time...it went perfect.

lizp123 posted: 2009-05-18 19:51:29

I have asthma so immediately i'm going to be registered with a Gynocologist at the hospital, medical reason!!

Denise posted: 2009-07-16 11:00:44

Esther kokkelmans is soon to be a doula trainer! she is simply super. by the way, a doula is not a replacement for prenatal education. in Eindhoven area I help ladies as a volunteer. I am a trained midwife and have a super team to refer to down here. international midwife, doula, english speaking repat childbirth educator etc etc etc. another thing to put straight: even in hospital, you will have a midwife. second line as they are called. so don't think hospital = doctor! i delivered in hospital 2x and am personally VERY pro midwifery in the hospital setting. still no guarantee, as just like in any country, people are people and not machines = mistakes can happen but not only in the Netherlands!
i would strongly advise as many of you as possible to hire in a doula too! you will not regret it!

JadEd posted: 2009-11-08 14:41:32

I wonder how the Dutch explain that they have one of the highest infant mortality rates in Europe....

Jonathan posted: 2010-01-05 18:31:33

It's no longer valid that one MUST go to a midwife. If your insurance will pay, and many do nowadays, you can go to a hospital and have doctors guide the pregnancy and birth. You can also ask for and receive an epidural. This is now an official medical guideline in The Netherlands. My wife and I went to the Vrije Universiteit hospital in Amsterdam and the care, while not always the warmest (Dutch doctors are seldom "friendly"), was very professional and thorough. Every request was met and the nurses were fantastic.

Denise posted: 2010-01-06 13:01:38

just remember, a hospital delivery is not a doctor delivery. there will be 2nd line midwives and only with complications will the gynae assist/take over. unless you are in a small local hospital. they mostly do not have doctors/nurses in training but are still most likely to have midwives too. BUT as a midwife, very favourable to 3 under 1 roof delivery departments, I hate home births because it takes just too long with complications to get to hospital! choose a hospital with 24 hour gynae coverage!

Jonathan posted: 2010-01-06 19:20:47

Hi Denise,

Actually, we never saw a midwife, we were led through the process by Interns who were very qualified and, in the end, the baby was delivered by a gynecologist. There were, I repeat, no midwives.

Denise posted: 2010-01-07 13:30:29

Hi Jonathan, you also have intern midwives. you will not know the difference. I did not say you will never have a dr! EVERY hospital in this country has it's OWN policy. down in Eindhoven area, you will hardly have a dr unless it's an assisted delivery. I merely want people to know that they must not think a hospital delivery = a gynaecologist!

Saule posted: 2010-07-12 11:32:11

Hello all,

I am from Kazakshtan and will be in Holland being in 5th or 6th months of pregnancy only. Of course my husband and I will be doing our best to get the residence permit and all insurance things but it will take time. What steps can i do before getting all papers straightened up? I would greatly appreciate any advise

Denise posted: 2010-07-12 16:08:09

where will you be staying? access Amsterdam and the Hague (den Haag) have a list of people who can help you. i can help if you're down in the greater Eindhoven area.

Saule posted: 2010-07-13 04:58:54

Thank you Denise for the reaction. We live in Utrecht for now. I would feel much better if there are people who could help us.

Gea Meijering posted: 2011-01-17 07:18:38

The Dutch guide "Kraamwijzer" with postpartum care information for mom and baby that is given to most new mom's in the Netherlands is available in ENGLISH.
Google "The First 8 Days of Being a Mom" and find out more. Also available on Amazon.com.

Jill Roche posted: 2011-11-27 02:43:23

My Daughter who living in Amersfoort, is having her first babe @ 36 years .
Her partner weighed @ 9 lbs as a newborn.
I am so nervous about her having a homebirth. I am NZ RN and Maternity trained. Surely she can ask for a Hospital Delivery.
There would be no hesitation in New Zealand at all

exyspat posted: 2011-12-13 14:40:29

Hi Jill, you can have a baby in the hospital here but you have to pay for it. It costs about 300 Euro http://www.recommenda.nl/2011/11/27/annual-end-of-year-opportunity-to-switch-medical-health-insurance-providers/

Dutchy posted: 2012-01-12 16:43:57

I am not sure this article reflects reality too well, and the posted responses don't make it any better.

Dutch women often choose to have a home birth. But can equally choose a hospital birth. The claim about it not being covered by insurance policies is nonsense. ALL insurance policies cover this. There are some policies however that charge you the deductible for child birth. That deductible (eigen risico) is higher in case of a hospital birth (can be up to €300) than a home birth (can be up to €90). But it is up to you which insurance policy you choose.

Also, infant mortality in The Netherlands is not high, as some here claim. In fact it is lower than in the UK, Ireland, US, Australia or New Zealand, just to name a few (http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate) .

Also keep in mind that the average distance from home to a hospital in The Netherlands is 5,2km (3.2 miles), so if anything goes wrong, you'll be in the hospital in a heartbeat.

Mavis posted: 2012-01-17 17:43:39

I am almost 6 months pregnant and the posts here have been very helpful. In my experience, I find that it is unfortunate that some insurance companies in the netherlands (unless you are willing to pay higher premiums) will cover a home birth but not a hospital birth unless the mother has some sort of pre-exisiting medical condition. I believe that this nullifies the existence of "choice" for the pregnant mother because although she may choose her choice is limited to her ability to self finance the hospital birth/ or having a pre-exisiting medical condition.

Dutchy posted: 2012-01-19 12:53:50

@Mavis: As I said in the post above yours: it is not true that insurance companies do not cover hospital birth! The cost of a hospital child birth is thousands of €s, and will always be covered.

Some companies do charge you a deductible, which is something totally different than not covering the costs. But -again- that is easily prevented by choosing an insurance company that does not charge you this deductible for child birth. Just read the fine print, and switch insurance companies.

Personally I do find it unethical to make a distinction between home- or hospital birth, even if it is only the deductible that they charge.

Adek posted: 2012-03-25 09:21:24

Hi,

Can you please point me to insurances which covers delivery in hospital? I have another question. Are IVF covered by insurance if paid extra?

Susan posted: 2012-04-20 23:44:16

In a recent study they linked post natal depression to a long delivery with no drugs. Apparently having an epidural showed that the women actually had bonded better to their babies one month on..... the stress to both mother and baby during the birth can have some nasty knock on effects... What do you want - birth being a wonderful and joyful experience or the reality which is it is painful as hell and pain relief stops the mother from hyperventilation and extreme stress. I have two kids and one i had naturally ( i would never recommend this to anyone) and the other had with drugs. I was better equipped to deal with the second after birth and had much less downtime. [Edited by moderator] you wouldn't have dental surgery without anaesthetic , but technically it would be more 'natural' to do this. You allow people to buy grass on every corner which effectively anaesthetises them, you allow euthanasia but you campaign heavily against a woman having pain relief during child birth.

Kevin L posted: 2012-07-23 13:17:14

Like all things natural -- it's great when it works out, extremely stressful and even sad when it doesn't work as planned.

In this day and age, I can only ask you to consider this: "Why gamble with your and your baby's life by not having a doctor present?" I argue that the old way of home birth is an outdated and potentially life threatening practice. Great when it works, but ultimately a huge risk of lives. The Netherland's home birth statistics are all the proof needed to make that point.

I'm an ex-pat American and my wife is Dutch. We had our only child in January 2012. Originally planned on home birthing for the simple reason that we wanted the home atmosphere and no medical interference.

Short story: Due to lack of fluid in the womb, we were forced to induce labor 3 weeks early at a hospital. They used a balloon method, no drugs in this event at all, ever. In the end, we had what amounted to a home birth, but in the confines of a dimly lit quiet room at LUMC Leiden. Their maternity wing is second to none. I have never seen or experienced such natural, human surroundings. A staff that went above and beyond any assistance I had ever seen in an American hospital.

We both walked away wondering why anyone would risk a non-doctor assisted birth in 2012?? Also -- fair warning -- 'kraamzorg' may sound wonderful in theory but, in reality it is a 50-50 chance as to whether or not your visiting nurse (and follow-up visits at your local office) are helpful. Our kraamzorg experiences, with the exception of 2 out of 5 'qualified' assistants, were not the most helpful of experiences.

So ask yourself just how much you care to gamble on your life, or your baby's life, before being sold on the home birth route.

Elizabeth posted: 2012-08-07 18:13:00

If you want to be treated well, get a private health insurance. In fact with the international healthcare insurance Indigo Expat you can add the option Maternity (this is not standard included in the policy, so you don't pay for maternity if you don't need it) check out their website: http://www.indigo-expat.com/

Michelle posted: 2012-08-13 11:48:48

Firstly @ Adek, I added the 'Family Plan' option from AGIS ($25 euros extra per month) after finding out I was pregnant and it covered the hospital birth with no problems. :-)

As for the birthing/maternity process in the NL, I can only speak from my experience but overall I found the Dutch process caused more aniexty than needed. I moved to NL last year with my Dutch husband and quickly became pregnant a month later. Having had 5 miscarriages in the US I immediately went to the Dr and was told that it was too early for me to be seen and to come back when I was 3 months and/or contact a midwife for care. After several phone calls explaining the situation of the miscarriages I was seen by the International Health Centre of the Hague by a Gynocologist and told they would monitor the pregnancy with visits every 2 weeks. This visits usually lasted only 10 minutes and simply involved ultrasound and bloodpressure checks. During this time, I had two respiratory infections and the flu and was refused antibotics. I truly felt like I was not receiving what I thought was 'normal' care. At 20 weeks I was sent to an ultrasoud center for the 5 month checkup and at 7 months refered to the Gynocology dept at Bronovo because only the hospital gynocologists can oversee a birth and they needed to become familar with my case. I also am diabetic and although I had also been under a Dr's advice in regards to this and my pregnancy, I had to register and switch to a diabetic Dr and specialist at the Hospital at 7 months. This was my real first moment of aniexty... having the files from the Health Centre to the hospital transferred was somewhat problimatic and in the end I had to have multiple duplicate bloodtests done because the hospital needed them before ''allowing" me to give birth. Coming from the US, I had never had this issue as everything was electronically connected between hospitals and Dr's offices in my area. (NC- Carolinas Healthcare Systems) My next point of aniexty was having the insurance inquire about why I wanted to give birth in a hospital and whether it was medically necessary. I felt offended that they asked but honestly other than asking they didn't try to persuade me to change to a homebirth just adviced me of my options. (homebirth, hospital or birthing centre). The last point of aniexty before birth was general information given verses what actually happened. I said upfront I wanted an epideral. I was again met with, "if medically necessary" but this time by the Drs. On the day of my daughter's birth, I was approached by a Dr on the ward and told that if I wanted to have the epidural, I needed to have it then because the anesthesiologist was on the ward and would be difficult to get ahold of later. I was only 4 hours into labor so by the time my daughter was ready to come I had regained all feeling and was begging for pain medication the last 3 hours of labor. None was given. This was hands down the most tramatic part of the whole situation. I was in a hospital and there was no help to be found. The only thing that kept me from having a complete breakdown during this whole bit was a supervising Dr coming in and grabbing me by the shoulders and talking me down from a pained frenzy.

My conclusion on the maternity situation here is this.... if you want a hospital birth and to be under a doctor's care... INSIST on it and they will willingly let you without much fuss. That being said, take advantage of all the natural birth resources available to you because most likely the experience you get in the hospital is not going to be like you would have in your home country. It may suck even but truth is withall the medical interventions I accepted in the US to sustain my pregnacies... it was the more holistic approach and the noninvasive nature of the care I received that allowed this one to be successful.

Dinah Heeringa-Jordet posted: 2013-04-18 22:53:57

For an amazing counter to all the pessimism flowing from this article, here is the other side of the argument, an article "The Dangers of Hospital Birth" written by a midwife in CA, USA. I am an expatriate living in the Netherlands, just miscarried my first baby. While I was pregnant I read and was quite alarmed by Amanda Van Mulligen's article. Further research convinced me that home births are far superior to hospital births. It's all here in this article. Please read the real story:

http://www.gentlebirth.org/ronnie/hospitalDangers.html

Rondom de Geboorte posted: 2013-07-10 14:11:11

Rondom de Geboorte has a prenatal course in English given in the West of Amsterdam. Thursdays at 1.30 pm for eight weekly sessions of exercise combined with information. It only costs €45,-. See for information and applying www.rondomdegeboorte.nl

Alex posted: 2013-08-13 13:51:08

We recently gave birth in the Zaanse Medical center to our little baby girl... I heard so many horror stories from grumpy expats who think that their own countries health care is far better than the Dutch.. Well those people are all wrong. It was a magical experience and the care we were given was amazing. From the post natal to the Pre natal care we were astounded by the level of skill and compitence that was shown. The delivery team and pediatrics were perfect..

I think provincial Dutch hospitals are just the best

An English Expat.

helena posted: 2013-11-26 15:02:51

Sorry, but never again in the Netherlands EVER!!!!!! They refuuuuuse to give you an injection to get pain relief. They keep on insisting for having a 'natural birth' (=enduring the pain even when it lasts forever..) I asked my Dutch girl friend (works at the hospital) why is that, and she replied they like to keep the process low cost. Which also explains why they insisted on me NOT getting to the hospital. I did ask, hell, i begged to be issued the pain relief and i begged to be allowed to go to hospital: but they will simply refuse to let me. And when i say they refuse, i mean they REFUSE. (and you are not allowed to just 'show up' at the hospital to have it your way). At the end, we still had to go, but it was obviously a nightmare to go there in my state!! [Edited by moderator]

Rita posted: 2014-02-04 14:56:20

[Edited by moderator. Please post (elaborate) questions on Ask the Expert or on our Forums. If you have questions for the Expatica staff, please contact us directly.]

Sophie posted: 2014-02-12 14:35:38

I am a student midwife in the uk, We get to do a placement abroad and I would like to come to Rotterdam and work with some midwives- can anyone recommend any midwives as I have no idea where to start. I do not, unfortunately, speak Dutch. Thank you.

28 reactions to this article

Ams posted: 2009-05-13 15:10:13

"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"- I doubt about this line. I just gave birth 2 months ago in the hosp but we did'nt arrange anything (we dont have to) in the hospital prior to the delivery. Unless you're scheduled for CS, than you have to arrange that. For normal delivery, your midwife will call the nearest hospital if your about 4-5cm dilation (ontsluiting). Our plan was to stay at home for my early labor and go to the hosp when it's time...it went perfect.

lizp123 posted: 2009-05-18 19:51:29

I have asthma so immediately i'm going to be registered with a Gynocologist at the hospital, medical reason!!

Denise posted: 2009-07-16 11:00:44

Esther kokkelmans is soon to be a doula trainer! she is simply super. by the way, a doula is not a replacement for prenatal education. in Eindhoven area I help ladies as a volunteer. I am a trained midwife and have a super team to refer to down here. international midwife, doula, english speaking repat childbirth educator etc etc etc. another thing to put straight: even in hospital, you will have a midwife. second line as they are called. so don't think hospital = doctor! i delivered in hospital 2x and am personally VERY pro midwifery in the hospital setting. still no guarantee, as just like in any country, people are people and not machines = mistakes can happen but not only in the Netherlands!
i would strongly advise as many of you as possible to hire in a doula too! you will not regret it!

JadEd posted: 2009-11-08 14:41:32

I wonder how the Dutch explain that they have one of the highest infant mortality rates in Europe....

Jonathan posted: 2010-01-05 18:31:33

It's no longer valid that one MUST go to a midwife. If your insurance will pay, and many do nowadays, you can go to a hospital and have doctors guide the pregnancy and birth. You can also ask for and receive an epidural. This is now an official medical guideline in The Netherlands. My wife and I went to the Vrije Universiteit hospital in Amsterdam and the care, while not always the warmest (Dutch doctors are seldom "friendly"), was very professional and thorough. Every request was met and the nurses were fantastic.

Denise posted: 2010-01-06 13:01:38

just remember, a hospital delivery is not a doctor delivery. there will be 2nd line midwives and only with complications will the gynae assist/take over. unless you are in a small local hospital. they mostly do not have doctors/nurses in training but are still most likely to have midwives too. BUT as a midwife, very favourable to 3 under 1 roof delivery departments, I hate home births because it takes just too long with complications to get to hospital! choose a hospital with 24 hour gynae coverage!

Jonathan posted: 2010-01-06 19:20:47

Hi Denise,

Actually, we never saw a midwife, we were led through the process by Interns who were very qualified and, in the end, the baby was delivered by a gynecologist. There were, I repeat, no midwives.

Denise posted: 2010-01-07 13:30:29

Hi Jonathan, you also have intern midwives. you will not know the difference. I did not say you will never have a dr! EVERY hospital in this country has it's OWN policy. down in Eindhoven area, you will hardly have a dr unless it's an assisted delivery. I merely want people to know that they must not think a hospital delivery = a gynaecologist!

Saule posted: 2010-07-12 11:32:11

Hello all,

I am from Kazakshtan and will be in Holland being in 5th or 6th months of pregnancy only. Of course my husband and I will be doing our best to get the residence permit and all insurance things but it will take time. What steps can i do before getting all papers straightened up? I would greatly appreciate any advise

Denise posted: 2010-07-12 16:08:09

where will you be staying? access Amsterdam and the Hague (den Haag) have a list of people who can help you. i can help if you're down in the greater Eindhoven area.

Saule posted: 2010-07-13 04:58:54

Thank you Denise for the reaction. We live in Utrecht for now. I would feel much better if there are people who could help us.

Gea Meijering posted: 2011-01-17 07:18:38

The Dutch guide "Kraamwijzer" with postpartum care information for mom and baby that is given to most new mom's in the Netherlands is available in ENGLISH.
Google "The First 8 Days of Being a Mom" and find out more. Also available on Amazon.com.

Jill Roche posted: 2011-11-27 02:43:23

My Daughter who living in Amersfoort, is having her first babe @ 36 years .
Her partner weighed @ 9 lbs as a newborn.
I am so nervous about her having a homebirth. I am NZ RN and Maternity trained. Surely she can ask for a Hospital Delivery.
There would be no hesitation in New Zealand at all

exyspat posted: 2011-12-13 14:40:29

Hi Jill, you can have a baby in the hospital here but you have to pay for it. It costs about 300 Euro http://www.recommenda.nl/2011/11/27/annual-end-of-year-opportunity-to-switch-medical-health-insurance-providers/

Dutchy posted: 2012-01-12 16:43:57

I am not sure this article reflects reality too well, and the posted responses don't make it any better.

Dutch women often choose to have a home birth. But can equally choose a hospital birth. The claim about it not being covered by insurance policies is nonsense. ALL insurance policies cover this. There are some policies however that charge you the deductible for child birth. That deductible (eigen risico) is higher in case of a hospital birth (can be up to €300) than a home birth (can be up to €90). But it is up to you which insurance policy you choose.

Also, infant mortality in The Netherlands is not high, as some here claim. In fact it is lower than in the UK, Ireland, US, Australia or New Zealand, just to name a few (http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate) .

Also keep in mind that the average distance from home to a hospital in The Netherlands is 5,2km (3.2 miles), so if anything goes wrong, you'll be in the hospital in a heartbeat.

Mavis posted: 2012-01-17 17:43:39

I am almost 6 months pregnant and the posts here have been very helpful. In my experience, I find that it is unfortunate that some insurance companies in the netherlands (unless you are willing to pay higher premiums) will cover a home birth but not a hospital birth unless the mother has some sort of pre-exisiting medical condition. I believe that this nullifies the existence of "choice" for the pregnant mother because although she may choose her choice is limited to her ability to self finance the hospital birth/ or having a pre-exisiting medical condition.

Dutchy posted: 2012-01-19 12:53:50

@Mavis: As I said in the post above yours: it is not true that insurance companies do not cover hospital birth! The cost of a hospital child birth is thousands of €s, and will always be covered.

Some companies do charge you a deductible, which is something totally different than not covering the costs. But -again- that is easily prevented by choosing an insurance company that does not charge you this deductible for child birth. Just read the fine print, and switch insurance companies.

Personally I do find it unethical to make a distinction between home- or hospital birth, even if it is only the deductible that they charge.

Adek posted: 2012-03-25 09:21:24

Hi,

Can you please point me to insurances which covers delivery in hospital? I have another question. Are IVF covered by insurance if paid extra?

Susan posted: 2012-04-20 23:44:16

In a recent study they linked post natal depression to a long delivery with no drugs. Apparently having an epidural showed that the women actually had bonded better to their babies one month on..... the stress to both mother and baby during the birth can have some nasty knock on effects... What do you want - birth being a wonderful and joyful experience or the reality which is it is painful as hell and pain relief stops the mother from hyperventilation and extreme stress. I have two kids and one i had naturally ( i would never recommend this to anyone) and the other had with drugs. I was better equipped to deal with the second after birth and had much less downtime. [Edited by moderator] you wouldn't have dental surgery without anaesthetic , but technically it would be more 'natural' to do this. You allow people to buy grass on every corner which effectively anaesthetises them, you allow euthanasia but you campaign heavily against a woman having pain relief during child birth.

Kevin L posted: 2012-07-23 13:17:14

Like all things natural -- it's great when it works out, extremely stressful and even sad when it doesn't work as planned.

In this day and age, I can only ask you to consider this: "Why gamble with your and your baby's life by not having a doctor present?" I argue that the old way of home birth is an outdated and potentially life threatening practice. Great when it works, but ultimately a huge risk of lives. The Netherland's home birth statistics are all the proof needed to make that point.

I'm an ex-pat American and my wife is Dutch. We had our only child in January 2012. Originally planned on home birthing for the simple reason that we wanted the home atmosphere and no medical interference.

Short story: Due to lack of fluid in the womb, we were forced to induce labor 3 weeks early at a hospital. They used a balloon method, no drugs in this event at all, ever. In the end, we had what amounted to a home birth, but in the confines of a dimly lit quiet room at LUMC Leiden. Their maternity wing is second to none. I have never seen or experienced such natural, human surroundings. A staff that went above and beyond any assistance I had ever seen in an American hospital.

We both walked away wondering why anyone would risk a non-doctor assisted birth in 2012?? Also -- fair warning -- 'kraamzorg' may sound wonderful in theory but, in reality it is a 50-50 chance as to whether or not your visiting nurse (and follow-up visits at your local office) are helpful. Our kraamzorg experiences, with the exception of 2 out of 5 'qualified' assistants, were not the most helpful of experiences.

So ask yourself just how much you care to gamble on your life, or your baby's life, before being sold on the home birth route.

Elizabeth posted: 2012-08-07 18:13:00

If you want to be treated well, get a private health insurance. In fact with the international healthcare insurance Indigo Expat you can add the option Maternity (this is not standard included in the policy, so you don't pay for maternity if you don't need it) check out their website: http://www.indigo-expat.com/

Michelle posted: 2012-08-13 11:48:48

Firstly @ Adek, I added the 'Family Plan' option from AGIS ($25 euros extra per month) after finding out I was pregnant and it covered the hospital birth with no problems. :-)

As for the birthing/maternity process in the NL, I can only speak from my experience but overall I found the Dutch process caused more aniexty than needed. I moved to NL last year with my Dutch husband and quickly became pregnant a month later. Having had 5 miscarriages in the US I immediately went to the Dr and was told that it was too early for me to be seen and to come back when I was 3 months and/or contact a midwife for care. After several phone calls explaining the situation of the miscarriages I was seen by the International Health Centre of the Hague by a Gynocologist and told they would monitor the pregnancy with visits every 2 weeks. This visits usually lasted only 10 minutes and simply involved ultrasound and bloodpressure checks. During this time, I had two respiratory infections and the flu and was refused antibotics. I truly felt like I was not receiving what I thought was 'normal' care. At 20 weeks I was sent to an ultrasoud center for the 5 month checkup and at 7 months refered to the Gynocology dept at Bronovo because only the hospital gynocologists can oversee a birth and they needed to become familar with my case. I also am diabetic and although I had also been under a Dr's advice in regards to this and my pregnancy, I had to register and switch to a diabetic Dr and specialist at the Hospital at 7 months. This was my real first moment of aniexty... having the files from the Health Centre to the hospital transferred was somewhat problimatic and in the end I had to have multiple duplicate bloodtests done because the hospital needed them before ''allowing" me to give birth. Coming from the US, I had never had this issue as everything was electronically connected between hospitals and Dr's offices in my area. (NC- Carolinas Healthcare Systems) My next point of aniexty was having the insurance inquire about why I wanted to give birth in a hospital and whether it was medically necessary. I felt offended that they asked but honestly other than asking they didn't try to persuade me to change to a homebirth just adviced me of my options. (homebirth, hospital or birthing centre). The last point of aniexty before birth was general information given verses what actually happened. I said upfront I wanted an epideral. I was again met with, "if medically necessary" but this time by the Drs. On the day of my daughter's birth, I was approached by a Dr on the ward and told that if I wanted to have the epidural, I needed to have it then because the anesthesiologist was on the ward and would be difficult to get ahold of later. I was only 4 hours into labor so by the time my daughter was ready to come I had regained all feeling and was begging for pain medication the last 3 hours of labor. None was given. This was hands down the most tramatic part of the whole situation. I was in a hospital and there was no help to be found. The only thing that kept me from having a complete breakdown during this whole bit was a supervising Dr coming in and grabbing me by the shoulders and talking me down from a pained frenzy.

My conclusion on the maternity situation here is this.... if you want a hospital birth and to be under a doctor's care... INSIST on it and they will willingly let you without much fuss. That being said, take advantage of all the natural birth resources available to you because most likely the experience you get in the hospital is not going to be like you would have in your home country. It may suck even but truth is withall the medical interventions I accepted in the US to sustain my pregnacies... it was the more holistic approach and the noninvasive nature of the care I received that allowed this one to be successful.

Dinah Heeringa-Jordet posted: 2013-04-18 22:53:57

For an amazing counter to all the pessimism flowing from this article, here is the other side of the argument, an article "The Dangers of Hospital Birth" written by a midwife in CA, USA. I am an expatriate living in the Netherlands, just miscarried my first baby. While I was pregnant I read and was quite alarmed by Amanda Van Mulligen's article. Further research convinced me that home births are far superior to hospital births. It's all here in this article. Please read the real story:

http://www.gentlebirth.org/ronnie/hospitalDangers.html

Rondom de Geboorte posted: 2013-07-10 14:11:11

Rondom de Geboorte has a prenatal course in English given in the West of Amsterdam. Thursdays at 1.30 pm for eight weekly sessions of exercise combined with information. It only costs €45,-. See for information and applying www.rondomdegeboorte.nl

Alex posted: 2013-08-13 13:51:08

We recently gave birth in the Zaanse Medical center to our little baby girl... I heard so many horror stories from grumpy expats who think that their own countries health care is far better than the Dutch.. Well those people are all wrong. It was a magical experience and the care we were given was amazing. From the post natal to the Pre natal care we were astounded by the level of skill and compitence that was shown. The delivery team and pediatrics were perfect..

I think provincial Dutch hospitals are just the best

An English Expat.

helena posted: 2013-11-26 15:02:51

Sorry, but never again in the Netherlands EVER!!!!!! They refuuuuuse to give you an injection to get pain relief. They keep on insisting for having a 'natural birth' (=enduring the pain even when it lasts forever..) I asked my Dutch girl friend (works at the hospital) why is that, and she replied they like to keep the process low cost. Which also explains why they insisted on me NOT getting to the hospital. I did ask, hell, i begged to be issued the pain relief and i begged to be allowed to go to hospital: but they will simply refuse to let me. And when i say they refuse, i mean they REFUSE. (and you are not allowed to just 'show up' at the hospital to have it your way). At the end, we still had to go, but it was obviously a nightmare to go there in my state!! [Edited by moderator]

Rita posted: 2014-02-04 14:56:20

[Edited by moderator. Please post (elaborate) questions on Ask the Expert or on our Forums. If you have questions for the Expatica staff, please contact us directly.]

Sophie posted: 2014-02-12 14:35:38

I am a student midwife in the uk, We get to do a placement abroad and I would like to come to Rotterdam and work with some midwives- can anyone recommend any midwives as I have no idea where to start. I do not, unfortunately, speak Dutch. Thank you.

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A guide to telephone, internet and television along with utility services water, electricity and gas in the Netherlands.

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Giving birth in the Netherlands

The challenges and benefits of the maternity system in the Netherlands and how it differs to other countries.