Editor Natasha Gunn tries to answer readers' questions about having a baby in Holland.

As a first time mother to be I found the article Having a baby in Holland to be quite terrifying. There are horror stories about childbirth no matter which country you live in, I don't think it is necessary to draw attention to these to women who are already anxious about experiencing childbirth away from home. I agree that some information like requesting pain relief in advance is helpful as you wouldn't necessarily think about that, but perhaps an article with more facts and information about finding a midwife, how to go about organising the kraamzorg and such like would be more helpful.

Regards,
Angela

Dear editor,

I'm 22 years old and from Latin  America,  Peru. I live in  Den Haag  and  I’m  near to  eight months  pregnant. During all my check-ups with the midwife, they didn’t give all the information that I wanted. I mostly got the information from Spanish language websites. I just read about a Spanish woman living in Holland who asked for an epidural in Holland when she was having contractions but the doctor told her that they don’t give epidurals because they are too expensive.   I don’t understand why, considering the economy is better in Holland than in Latin America and this country is more highly developed than Latin America.

Regards,
Sindy

The editor replies:

Dear Angela and Sindy,

I did some research - as well as drawing on my own experience of giving birth at home twice in Holland - in an attempt to answer your questions, and at least point you to reliable sources of information.

Finding a midwife

Word-of-mouth is always the best way to find a midwife in your area, but if you don’t know anyone who can help then visit the Royal Dutch Organisation of Midwives (KNOV) KNOV website. From the homepage, click on the right-hand icon called 'zoek een verloskundige' and fill in your postcode. This will give you a list of KNOV member midwives in your neighbourhood. You can always change your midwife during the pregnancy should you wish to.

Language

Monique Schers of Koninklijke Nederlandse Organisatie van Verloskundigen (KNOV) says, "Of course there will be some KNOV midwives who speak Spanish, Turkish, French or other languages, but we don't list such information."

Again, ask around and you may find the midwife who also speaks your mother tongue.

Join a birth preparation class

Not only will this help you to strengthen your mind and body for the birth, but you will meet other women who are going through the same experience and be able to exchange information regarding your experiences with the system, or simply talk about how you  and your partner are feeling. This view is backed up by Monique Schers of the KNOV who says "We think it is good to prepare for the delivery by following birth preparation classes. Several midwives organise these classes."

Experienced pregnancy yoga teacher Joyce Pula says that when you choose a pregnancy yoga class, find out whether the focus is on breathing and relaxation or on more vigorous stretching exercises, and select one which suits you. She also believes that it is a misconception that pregnancy yoga classes are only for women planning to give birth at home the 'natural way'. Whether you choose to have a baby in hospital or ask for an epidural, is personal; preparation classes can only empower a woman and make her feel positive about giving birth, she says. Yoga will keep women fit during the pregnancy, which will help labour and recovery.

I was lucky enough to have a good friend recommend Lillith Turk's childbirth preparation classes to me, and her classes are very energetic. On reflection, I am not sure how things would have gone had I not followed her teaching, which focusses on building up the mother's physical strength in preparation for childbirth, teaching postures to adopt for different situations during the birth, as well as dealing with the many fears or questions raised about labour and childbirth.

My experience of giving birth in Holland has only been good, and I gave birth at home to two babies, with 14 months between them, without feeling the need for pain killers. But this is a very personal subject, and pain killers can be necessary as well as useful during labour.

Epidurals

Childbirth educator Marijke Maclachlan believes that the minimal use of epidurals in Holland isn't just about the money. "Epidurals can cause a cascade or interventions, and there are risks associated, but you will be given one if needed," she says. Maclachlan explains that if a woman is not relaxed because she is afraid of pain, this will hinder effective labour. In such a case an epidural can help her to relax and potentially shorten a lengthy labour. Doctors may choose to administer other pain killers in the middle of active labour, such as morphine-based Pethidine.

Monique Schers of KNOV says, "If you speak about pain with your midwife and say that you want an epidural in advance, it is possible to arrange for this. The image about midwives; that they don't want to give you an epidural or arrange one for you, is totally wrong these days. About ten to fifteen years ago, the midwives were more against pain relief, but nowadays this is an outdated image.

"The midwives now want to speak to you in a serious way about pain relief and why you want it. Most of time women ask for pain relief due to their fear about the delivery. If you really want to arrange an epidural in advance, the midwife will try to arrange it for you. The midwife, however, may encounter problems due to the logistical organisation within hospitals.

"The Dutch anaesthesiologists don't work for pregnant women during nights and weekends, and that is what the KNOV, together with the organisations for gynaecologists and anaesthesiologists are trying to solve now. In half a year these logistics problems should get better through our solving these together."

Labour is a natural process

Maclachlan sees that on the upside, the Netherlands is becoming more 'medicalised' and is now following birth protocols and therefore more drugs will be more readily available. But, on the down side, both the protocols and 'medicalisation' can interfere with the natural process of childbirth, she says. For instance, "a midwife could give you two hours of pushing time and then decide this is the point to assist with ventouse, or forceps. In a more relaxed environment, preferably the home, without such time limits, a woman will find that the hormones work better – are more in balance – and the process can proceed naturally," says Maclachaln.

Organising Kraamzorg (after-care programme)

Every family has to contact their own insurance company or a kraamzorg company directly to arrange kraamzorg, explains Monique Schers of KNOV.

Schers says, "Around the seventh month of pregnancy, a person from the kraamzorg company visits the family and gives an indication of how many hours kraamzorg you are entitled to. This indication depends on several factors such as if help is available from the father or other family members in the first weeks after delivery, or if the mother has medical problems which could complicate the delivery.

"These indication factors are part of guidelines that are used by every kraamzorg organisation in the Netherlands. In general kraamzorg care is, in the first instance for mother and child, and after that, if there is any time over, they care for the rest of the family – for instance other children. But in general cooking and cleaning are not part of their job."

A list of birth preparation classes

Amsterdam

Sai Mithra yoga centre
Joyce Pula and Joan Duyndam
Pregnancy yoga classes throughout the pregnancy (12-42 weeks) plus an additional 6-weeks of preparing for birth classes, which are focused on different breathing techniques, posture and massage during labour and mental preparation.
www.saimithra.nl
 
Lillith Turk
Lillith is a leading practitioner of safe natural child-birth preparation and baby massage. She also provides childbirth educators with practical training in these methods.
www.activehealthcenter.nl

Pascale Bonnet, a French yoga, pregnancy yoga and massage practitioner.
www.pascalebonnet.nl/

Amstelveen

Bump and Beyond
(Run by childbirth educator Marijke Maclachlan)
www.bumpandbeyond.nl

The Hague

Great Expectations
(Run by childbirth educator Tina Keogh)
www.greatexpectations.nl

Delft

For information on maternity and childcare assistance in Delft visit Delft MaMa, a not for profit organisation set up by expat Lucie Cunningham.
www.delftmama.nl.

Other useful websites

The birth-doula is a relatively new phenomenon in the Netherlands. For women who truly are in culture-shock and facing strong negative answers to their requests, Delft MaMa's  Lucie Cunningham recommends that they hire a doula if they can afford it.
www.doula.nl

Parenting in Holland

Information in English, for people living in the Netherlands, about pregnancy, birth and parenting issues.
www.parentinginholland.com

ACCESS
A not-for-profit organisation supporting the International Community
in The Netherlands. ACCESS' excellent book Babies and Toddlers has just been updated and reprinted (November 2007).
www.access-nl.org  

Translation of KNOV guidelines on Parenting in Holland

Natasha Gunn
Editor
Expatica Netherlands

28 March 2007

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[Copyright Expatica 2007]