Introduction
Maternity care in the Netherlands has an excellent reputation. There is a strong emphasis on natural childbirth (drug free with minimal medical intervention). If however, problems are anticipated or occur unexpectedly, the hospital based obstetric team will take over. For a family friendly resource on having a baby and parenting in the Netherlands (in English), Parenting in Holland.
Selecting a carer and location of delivery
Most women take a home pregnancy (zwanger - pregnant, zwangerschap - pregnancy) test, for which kits are available at the drugstore/pharmacy. You can request a confirmation blood test at your doctors.
If there are no anticipated problems with the pregnancy or delivery, the usual choice of carer is a midwife (verloskundige). Midwives operate independently of the hospital and you will be solely under their care during both pregnancy and delivery. However if problems do occur, (high blood pressure, diabetes) you will be referred to an obstetrician/gynacologist who will take over your care.
Under the care of a midwife you can choose between a home delivery (thuisbevalling) or a short stay hospital delivery (polikliniek bevalling), where you will deliver in hospital and be discharged within six hours. This is of course, no hard and fast rule but if everything goes well, you will not be kept in hospital for longer than necessary. If you choose a hospital delivery, you should make arrangements with the hospital before week 21 of your pregnancy.
To find a midwife you can look up verloskundigen under gezondheidzorg in your local gemeentegids. Alternatively, make an appointment with your doctor who will advise you who you need to contact.
Reasons for choosing consultant obstetric care are chronic medical conditions, past pregnancy and delivery related complications, diabetes, kidney or heart disease and also if you are over the age of 35, there is some flexibility on this last point. Your type of health insurance offers no advantages or disadvantages to care available.
Ante-natal care
Ante-natal care is usually delivered at the consulting rooms of your chosen carer. It follows the common pattern of monthly assessment until 32 weeks, providing all remains normal and thereafter more frequently.
Ultrasound scans are not routinely performed if you are under the care of a midwife. Everyone is entitled for one ultrasound scan to determine dates. This is not always offered and it is best to ask if not mentioned at your first visit to the midwife. If the midwife has no reason for concern you will not have another scan during your pregnancy. This can be rather strange and it is best to discuss it with your midwife. They are usually very flexible.
Blood tests are done routinely. If you want to know what they all are, just ask your carer. As with most things, information is not freely offered but given when requested.
Amniocentesis (buikprikje) or villi biopsy (vlokkenstest) are available when appropriate. Insurance will cover the cost of the investigation if it is medically recommended. You may have to travel to a teaching hospital for such special requests.
Ante-natal courses
Thuiszorg offers a wide range of courses for the pregnant and new mother, these include:
Exercise and relaxation courses for expectant mothers: Zwangerschapsgymnastiek. These highly recommended, especially if you are expecting your first baby and are planning a natural labour and delivery. Comprehension of Dutch is not essential as the exercises are demonstrated.
Parentcraft classes (Oudercursus). All you need to know about pregnancy and caring for baby. If you don't know Dutch, these classes may be a problem.
After the baby is born a variety of courses are available, including Baby massage and advice on how to deal with a crying baby - Huilbaby.
If you want some other form of birth preparation, eg. Yoga, you must make your own arrangements but your midwife or OB may be able to advise.
Access offer a wide range our classes from pre-natal exercise to breast feeding services.
Labour and delivery
Bevalling. Make sure you know by week 36 of your pregnancy, whom you should contact and how when you go into labour. Also have ready equipment (for home delivery), you will receive a list of items required from the Kraamverzorging when you register. Items such as bed verhogers (metal stilts to raise your bed, which can be hired from Thuiszorg). A suitcase should be packed and ready. It is usually assumed that the husband or partner will present at the delivery. If you wish to deliver in a particular position, make your wishes known well before hand.
If you are under obstetric medical care, all your obstetric examinations will be carried out by doctors. The nurses who bring your bedpans etc are unlikely to be midwives. You will be delivered by your own OB if he/she is on duty, otherwise by the OB on call.
Your midwife will explain to you when you must contact her and the procedures to follow at around 36 weeks, you should always have the midwife's phone number handy should you need it before that.
Post-natal help - Kraamverzorgster
Hospital
Post-natal practices vary between hospitals. Breast feeding is encouraged and you are given a lot of assistance if required. However, some maternity departments give supplementary feeds the first few days until the breast feeding has become established. If you do not want this, you must make it very clear.
Home
Part of the care during and after birth is the provision for a Kraamverzorgster. These are women who have received two years training to provide a combined post-natal care and home help. They also assist the midwife at a home delivery. There is no legal requirement to have professional care at home after the birth of the baby, but it is normal to do so and thoroughly recommended. From the women who have experienced having a kraamverzorgster, all say it is well worth it.
There are two types of Kraamverzorging.
Intern Kraamverzorgster: Works in your home an average of eight hours per day. They are usually very flexible. You can plan, with the kraamverzorgster, what hours she is most needed at the time. She will help care for other children in the family, do routine household cleaning and laundering, grocery shopping, preparing meals as well as caring for mother and baby, and receiving visitors.
Wijkkraamverzorging: The nurse comes into the home once or twice a day to give essential care and check the health of mother and baby. This is acceptable if it is your first child, although it is ideal to have someone around to help and advise with breast-feeding etc.
Both types usually terminate around the eighth post-natal day or earlier if it suits the family better. As of January 1st this year, the rules and services offered from medical insurance providers changed. Check with your provider what your cover will include.
If you really don't want to head home with your wee one quite so soon, and the hospital aren't having it, you have one other option. Het Kraamzorghotel, roughly translated is a hotel which offers rest, privacy and professional care 24 hours a day for mother and baby. Whether your insurer will pay for this service, will depend on your insurance policy and the length of your stay in the country and length of stay at the facility.
For more information:
Het Kraamzorghotel
Vliegveldweg 59-61, 3043NT
Rotterdam
Tel (010) 282 6270
Post-natal care and examinations
The kraamverzorgster will continue the care and the feeding regime begun in hospital. Inform your huisarts (family doctor) of the birth and homecoming if he/she has not been present at the birth. He/she will visit you at an early stage to check that all is well. If you have been in the care of a midwife, she will also visit on alternate days. On the eighth or ninth day, blood will be taken for the PKU heel-prick test. This blood is used for laboratory tests for two specific congenital conditions. They are both very rare, both cause severe mental handicap if untreated, both can be treated if diagnosed early.
The post-natal examination approximately six weeks after delivery is usually carried out by the person who looked after you antenatally. If you have been transferred from midwife to obstetric care, the obstetrician will decide who should conduct post-natal examination.
The purpose of the examination is to check that wounds have healed satisfactorily and the uterus has returned to its normal non-pregnant size and position. If you are unsure what to do about family planning (geboorteregeling), this is a good opportunity to discuss it.
Registration
Paperwork. By law, the baby's birth must be registered within three working days at the Gemeentehuis of the gemeente where the baby is born. The registrar is de ambtenaar van de burgerlijke stand.
Kinderbijslag. Once you register the birth, your child will automatically registered for the child benefit (AKW), which is paid every quarter. You should receive notification from the SVB within a couple of months after the birth of your child.
Dutch Customs
It is usual to send printed birth announcements to all your friends and acquaintances. Visit the printer (drukker) a few weeks before the baby is expected. Choose your design and arrange as much as possible. Most printers will tackle foreign languages, but beware of misunderstandings (ie. English pounds/weight).
Fathers, brothers, sisters and any other members of the family who happen to be around will be congratulated formally by Dutch friends and some friends may wish to arrange a formal visit with mother and baby. With due regard to convenient timing, this is known as kraambezoek. The Dutch love to come and visit, the birth of a child is a real cause for celebration! Visitors are served beschuit met muisjes, which are Dutch crispbakes topped with aniseed flavoured sugar balls, which are available at any supermarket in blue or pink.
The new father is not normally expected at work the day after the birth, in fact in most cases are given two days off. When he does return to work, he can join in the spirit of the occasion by providing bescuit met muisjes for all his colleagues! Older children in Dutch schools also provide sweets or something to celebrate the birth of their sibling - this practice is called trakteren.
Important terms
