How does the pregnant expat cope in a country that favours home births and dismisses pain relief?

Expatriate women have the same dreams and hopes as women who never leave their home country. And for many that includes having children. But having children in a foreign country can add additional stress to the experience. It's not as simple as going to your family gynaecologist and saying: "I'm pregnant." The Netherlands strongly favours home births, natural childbirth (no pain relief) and the use of a midwife.

There seems to be a long history of stoic Dutch women following the orders of the medical system, not questioning if there is a better way. So how does the average expat woman cope? Fear of the unknown Many women react fearfully to the news that they were going to have their baby in The Netherlands. And many have no idea of what to expect, or they have had previous unpleasant experiences with Dutch medical care. As their pregnancies progressed, most found their fears disappeared.

In all regions of The Netherlands, midwives seemed willing to speak in both Dutch and some English, attempt to answer questions and offer support. Gill Rees and Chrissy Guido both felt their midwives became like friends. The women I spoke with found their personal requests were being considered - except for their need for pain relief. Demand what you want All the women recommend you state clearly and firmly from the beginning your desires regarding pain medication and pregnancy care - and you stick to your wishes.

Inform your medical practitioners that you are from a different country and want your own form of care, whether it be a pill, epidural or perhaps a caesarean section.

Nazeema Adams, who gave birth in The Netherlands, says: "Insist on what you want and have them write it down in your folder. While the midwives might not be there at the delivery, your folder will be."

But sometimes it doesn't work out the way you planned. Frances Jackson, whose previous child was delivered by c-section in Brazil, didn't want to repeat that experience in the Netherlands. "I was offered an epidural, but the Dutch anaesthesiologist took the hours to arrive and then just as he was about to administer the drug he was paged and left never to return".

Denison Davies also had a bad experience. "The midwife said it was not possible for an epidural but my doctor gave the go-ahead, since I was being induced. The anaesthesiologist left the hospital at 7pm and could not be recalled to administer an epidural to a woman in labour, I had to beg for pain medication and the nurse asked me why I needed it."

The delivery Many expats felt pressured by the midwives to have their child at home but for a variety of reasons - particularly fear for their safety in case of complications - they preferred to give birth in hospital.

Gill Reese found her two home birth experiences quite positive, however. "I gave birth at home and this was very intimate," she says. Gill found being able to use her own bathroom and being in familiar surroundings reduced the trauma of the experience. But there are many horror stories doing the rounds about the delivery, from vacuum extractions and untreated toxaemia to a woman left hanging onto her baby in a Rotterdam delivery room bleeding profusely with her legs up in stirrups because of a shift change. Luckily the cleaning lady found her.

However, most of the deliveries went fine and mother and baby were well and at home again within 24 hours. The aftercare bonus One thing that everyone loves in The Netherlands is the aftercare programme, or "kraamzorg".

Once mother and baby have arrived home there is a period of five to seven days that a "kraamverzorgster" will come over and help with everything, including feeding, changing, childminding, cooking and even cleaning.

Clare Smith says: "I think it is a fantastic service. It certainly gave me confidence and I could really enjoy my first week at home with the baby rather than being worn out and terrified and wondering what on earth I was meant to be doing." Would you do it again? Suzanne Pieters-Lemont felt her first experience in Groningen was negative and traumatic. However, having learned what to ask for and how to prepare herself she is looking forward to having her second baby in Utrecht.

Nazeema Adams agrees: "My second delivery was much better because I was better prepared." But Denison Davies says: "I would never give birth here again. The Dutch philosophy is too laissez-faire. My son and I almost died during childbirth".

A few other women echoed her sentiments. But most were in general pleased with their experience and would be happy to have a second or third baby here, as they know what to expect.

Prepare yourself Most women will admit they have heard the gamut of pregnancy horror stories from mothers, friends and sisters - regardless of what country they live in. In The Netherlands it is vital to make sure you get what you want, ensure you understand the process, educate yourself on all stages of your pregnancy and start to develop a support system among other expat women right from the start.

January 2002

 [Copyright Expatica 2002]