Carlie: Hey there, it’s Carlie with the Expat Focus podcast. I’m excited to be speaking to another Aussie on the show today. We both left Australia for careers in London, although that’s where the similarities end. Bec ended up moving to a village in the Austrian mountains, where she fell in love with a Dutchman and relocated to the Netherlands. After a few years, marriage happened, and then she became pregnant.
The first pregnancy is daunting for any woman, but add a foreign country and language into the mix, and there are a lot of unknowns. Bec has navigated pregnancy in the Netherlands twice now, and she has some great insights to share.
How were you feeling at the time, being pregnant and in a foreign country?
Bec: That’s a really good question. I mean, in terms of the healthcare and the support I would get, I knew I was in a great country to have a baby. The Netherlands is renowned for its excellent health services, hospital care and the rest, and social services. But what I did feel uncomfortable about was the, the language barrier.
So imagine, I arrived in 2010, and fell pregnant in I think February 2013. And, for the first couple of years while I was living in the Netherlands, I didn’t study the language very, as much as I should have. That was because I’d lived in Austria prior to that, and spent 3½ years trying to learn Dutch, sorry German, as hard as I could. So when I arrived in the Netherlands I thought oh, please, no new language!
Carlie: Your brain was burnt out!
Bec: Yeah, exactly! So at the time, I had basic Dutch, but my Dutch wasn’t as good as I would have liked it to have been to feel 100% comfortable. So it’s a really good question, because I actually, very early on in my pregnancy, I heard about doulas.
A doula is a woman, usually, that can guide you through birth. They’re not a midwife, they’re not usually a health professional or a doctor. They are really a birth coach. And they look more after the emotional needs and they talk to you before the birth and decide, help you to clarify what you’re hoping for in your birth, although birth is very unpredictable. But they help to understand what your wishes are in an ideal situation, and help you to guide towards that.
And, what was great about her, she was a Dutch lady living in Belgium, and she spoke fluent English. So all of these early conversations I had with her in English, and then she was there for me during the birth. So in addition to the Dutch services I had, I also employed myself a doula to just be there, to be someone who I knew in advance, who I could easily communicate with, who knew what I wanted, and support me at quite a, yeah, challenging time.
Carlie: The doula is one of the six points you’re gonna talk through today on things to, things to know about giving birth in the Netherlands. So we’ll probably speak more about the doula a little bit later on in this interview. But number 1 you’ve put as the midwife service and suitcase of information. Talk me through that.
Bec: Yeah, sure. So, when you first become pregnant in the Netherlands, you then register by a local midwife service. And normally it’s a small team of women in your local area, for example I live in a mid-sized town, and there was a team of about, between 4 and 6 midwives. And you would have regular appointments with them, at the beginning of your pregnancy the appointment is once a month, and then as you get towards the end of your pregnancy those appointments increase in frequency.
So you have for example every 2 weeks and then in the last month every week, an appointment with one of the midwives, and over the course of the appointments you get to meet all of them, because on the day of the birth, most people don’t know unless they’re hav-, opting for a Caesarean section, they don’t know when, what day they will be giving birth, and you never know which midwife is on duty that day. So over the course of those appointments you get to know all of them, and then you find out on the day which one will be your midwife. That was another reason why I opted for a doula, which is not part of the, at all part of the Dutch health service, it was an additional choice I made, but that’s so that I knew there would be a friend there on, I knew what I, partly what I would be getting on the day of the birth.
Carlie: Instead of just the random midwife that you, you met before but you don’t know which one?
Bec: Yes, and, and who I didn’t have quite as strong connection with, because they didn’t speak, a little bit of English, the communication wasn’t a problem, but they’d, you know, fairly quick visits, and you don’t get to know them in such a personal way as I did with the time I spent talking with my doula. And if ever I had a question during the pregnancy, I could just send her a WhatsApp, or even have a Skype call with her, and that, that was the whole point of that role, she was always there for me if I had any questions or any doubts.
Carlie: Now your second point on your list is to do with diagnostic services. Talk me through the hospital services in the Netherlands when you’re pregnant.
Bec: Up until the actual date of the birth, you really only have contact with the midwife, your midwife, local midwife service, unless you have something go wrong. So, unless you have a particular condition, or there are difficulties with your birth, or you have a pre-existing health condition that means you need special attention. It wasn’t until towards the end of my pregnancy that I had any contact with the hospital services.
Before that though, there is a programme of, of scans that you have here. So you, you have a scan very early on, I think it’s around about 12 weeks or so, you have your first scan. And then you have the 22 week scan, which is when they really go through every body part of the baby to check that it’s developing healthily. You can also have a test to check for Down’s Syndrome, and that is an optional test, so if you choose to have that test, then you pay extra for that.
Those services are also just as professional as the midwife service, and they really take the time to lead you through those scans, and at the end for example you receive a USB stick with photos, and sometimes even videos. At the time I didn’t have any videos, but I have since had friends who have also received the actual video footage taken during the scan, which is, is quite, you know, special and interesting to share with friends and family. I had about, I don’t know, about 12 different photos, they, they just select the best ones and put them on a USB, and I was able to send them straight home to mum and dad, email them and say here’s our little bean! Here, you know, get to know your grandson already. And that was really nice.
Carlie: And how did you navigate the language issue during those appointments?
Bec: Sometimes people, people spoke English to me. And later, if there was any difficulties most of the time my husband was there accompanying me. But that, that’s another reason why I opted for a doula, because as much as I love him, communication isn’t his strongest suit, and I’ve seen plenty of Hollywood movies where the, the husband seemed to become a bit overwhelmed during birth! So I wasn’t quite trusting what he would be like on the day of the birth, so that, that’s another reason why I went for a doula.
Carlie: A back-up communicator! (laughs)
Bec: Yeah, so I knew that would be someone explaining to me what was going on in English. I mean perhaps Mark would have my best interests in heart and be talking to the nurses or the doctors about what was going on, if something had gone wrong, but would he then be translating all of that all back to me and keeping me in the loop, especially if I’m not quite in the best state, so, that’s why I felt so much more comfortable knowing the doula would be there for me.
Carlie: And when it comes to birthing options we get to your third point on giving birth in the Netherlands. You say home birthing and no pain relief is very normal?
Bec: Incredibly normal. Even to the point that it’s, it’s seen as something incredibly strong and powerful. More and more people are opting to give birth in the hospital. Home birthing is definitely becoming less in the Netherlands. But in the past, the majority of people used to give birth at home. It’s a really big question a midwife asks you, is would you like to give birth at home, or would you like to give birth in the hospital? And both are fine. With my first son actually I was very close to maybe having to give birth at home, because when, by the time the midwife arrived I was very dilated and she said if you want to go to the hospital, we need to leave now (laughs). So…
Carlie: The clock’s ticking!
Bec: Yes, the clock is very much ticking! So, what does remain a really strong tradition here in the Netherlands is to try to give birth without pain relief. Pain relief is available, and of course lots of people do opt for it. But many many women have the intention here to give birth without pain relief. And, and I…
Carlie: How did you feel when you heard about that and, you know, in Australia I guess we’re very much told growing up that you, you have the epidural! You know, I know from my mother. So, how, how were you feeling about your options when it came to whether you would go natural or have some pain relief?
Bec: I agree with you actually, I grew up thinking oh yes, the epidural. But, it obviously comes down very much to personal choice and what people feel is right for them. I to be honest felt empowered by choosing not to have pain relief. My advice to any, any pregnant woman having a baby for the first time, would be to, why don’t you just see and try? Because, yes it’s painful, but it’s, it’s short-term painful. The feeling that you have, once you’ve achieved you feel so strong. It’s sorta like I am, I am woman, hear me roar, I can do this, I’ve done it. And, I found, yeah, I found it quite, quite empowering. The Dutch have a very strong approach towards that, but with, also very open to personal choice and what’s right for the mother involved.
Carlie: I was gonna say, obviously if they see that you’re struggling, or if you have complications, they’re not going to be holding back what you need.
Bec: No, absolutely not.
Carlie: You said you didn’t opt for home birthing for your first baby, although it was close. Are there any requirements if you do want a home birth? Do your midwives come and make sure that it’s the right space for you to be giving birth in, or…?
Bec: Yeah, that’s a really good question. And for everybody that happens, so regardless of whether you opt for a home birth or not, in the Netherlands, the midwife will come and visit your home. They will also check your home for suitability for birthing. For example you need to have a handrail on the, going up the stairs. They also look at the height of your bed. If the bed is too low you will be asked to get blocks or, or, we just used bricks to be honest, to lift up the height of the bed a few weeks before the birth, so that if you do end up giving birth at home, it’s at a, a correct working height for the midwife, the person helping with the birth.
Carlie: That’s really fascinating, I never thought about how a bed height would come into play.
Bec: Yeah, well that’s a sort of like occupational health issue, issue for these women that are delivering babies all the time. So that is how strong home birthing is within the Dutch culture. That they prepare the home, they prepare you for giving birth at home. Prior to the birth, you will receive a box.
It’s called a kraampakket, so a birthing box basically. It includes all of the things a midwife would need to help you deliver your baby at home. Or, even if the midwife doesn’t make it in time, for you and your husband, or whoever is there, to help you deliver your baby. For example, it includes a plastic mat to put on the bed. Sterile bandages, sterile equipment, cleaning, alcohol solution for the hands. And, after the birth, even if you have given birth in the hospital instead and not really used any of those items, there’s also a really strong culture here of donating that box to charity. So there are charities that then later collect these boxes from you, and send them to countries in need, for example countries in, in Africa.
Carlie: That’s a brilliant programme! And just the fact that they’re encouraging home birth so much, I would think, would take a lot of pressure off hospitals as well, you don’t have as many women in hospital beds giving birth because they’re at home.
Bec: The, the other thing that really takes the pressure off hospitals is normally, after you’ve had your baby in a hospital, you go home very quickly. So basically as soon as you are able, as soon as you’re in a condition that’s suitable to leave the hospital, but the support and care doesn’t stop there. What, what they have in the Netherlands, which is really the most incredible thing they have in the Netherlands, and the most amazing thing I’ve experienced whilst living in the Netherlands, is called the kraamzorg.
And what that means is sorta like the after birth care. They have professionals that come to your house, literally open the door for you when you arrive home from the hospital, so the first face you see, my parents were standing behind them, that lady, and welcome you to your home. They’ve already changed your bed, got clean sheets, they get you settle, you and your baby settled down, and they come for a period of 8 days.
So most women in the Netherlands, you can opt for somewhere between 24 hours and 49 hours of care, and that’s usually, that’s spread over 8 days. And some, sometimes due to the health of the mother or of the baby, that can also be extended. The woman comes for several hours a day, so for example, my kraamzorg lady came for about 6 hours a day. She would arrive at around 8 o’clock in the morning, and she did whatever was needed. So her primary purpose is to check my health and check the health of the baby. She would for example inspect the (laughs) my lower area and take my temperature, clean me, do the same checks for the baby, so, listen to the baby’s heart, check the pulse, temperature.
Her next focus then moves to looking after the needs of the baby, so for example, she teaches you essentially how to become a mother. She teaches you how to bath your baby and, and works very closely with both the mother and the father, so, if, if the father’s present. So in my case my husband, Mark and I were taught how to bath the baby, how to change a baby’s nappy, I know that sounds very simple, but (laughs) if you’ve never had anything to do with babies or children or nappies before, it’s very helpful, even to the point of how to roll up the nappy so it takes up the least volume when you put it into the rubbish bin, which in the end saves rubbish space.
Carlie: And you don’t have any accidental explosions anywhere.
Bec: Yeah, yeah, exactly! How to take your baby’s temperature, because you have to do that when, in the early days. How to put the baby down in the bed, with little towels rolled up around, near the head of the baby, so that the baby naturally sleeps on different sides and doesn’t get a flat head, ‘cause the baby’s head is very soft in the beginning, and if they always sleep on the same side then it does actually affect the, the shape of the head. So, with little towels…
Carlie: This is something I’d never thought about!
Bec: No, there’s so much! (laughs) Trust me! Other things that are, in the Netherlands what’s the, still a bit of a traditional and strange thing that they do is they use hot water bottles, but they are sort of metal canisters, where you put in boiling water, wrap them in towels, and put them in the baby’s bed. To me it seemed really, a little bit dangerous…
Carlie: Yes, I was gonna say, a little bit concerning!
Bec: Yeah (laughs). But apparently they’re fully secure and safe, and it helps to keep the baby warm. Oh, and most of all, they teach you, if you’re, if that’s what you want, they teach you how to breastfeed. Which can be a really tricky thing, and can be really challenging, and to have someone there to help and guide you, make sure the baby’s feeding correctly, to ensure that that does the least harm to you, and, and is, is done in the best way for your body as well, that is the most amazing support.
I remember, I think it was the third day, the baby, Sam had been screaming and crying, for most of the night we’d been up with him and were absolutely exhausted. And we were literally standing by the front door when she arrived at 8 o’clock the next morning, desperately wanting her advice on what we could have done better, or what we needed to do to calm him down, or he had some cramps, and was a very unhappy baby that night. And just to know that there’s someone coming to help you, someone who’s an expert, someone who knows exactly what to do, and has seen, met so many babies over so many years that they’ve got all kinds of strategies to try or advice to give, it’s just the most incredible support you could ever imagine.
Carlie: Bec, would you say that your crash course in being a mum kind of happened after you gave birth, or did you have any pre-birthing classes with your husband?
Bec: No. For my first child I, I didn’t do that, because I had done a bit of reading myself, and felt OK going into it. For the second birth I decided to do a sort of pregnancy yoga course, but it wasn’t so much yoga, it was more about breathing. So I learnt the more correct techniques for breathing, with my second son. I would say that at the end of those 8 days with the kraamzorg lady, I really felt confident. I felt like I knew what I needed to do to be a mother. And just to put it into perspective, the kraamzorg service is included as part, part of your health insurance. So at that time I used to pay about €105 a month, every, health insurance is mandatory in the Netherlands, you have to pay a monthly contribution towards health insurance.
At the time I paid about €105-108, it’s now up to about €124. And all of the services I’ve mentioned are included in that cost, including the stay at the hospital for the first night, and the kraamzorg service is included in that as well, but there is a small portion that you have to pay on top of that. And it’s €4.30 an hour. So basically next to nothing, for that incredible service.
Carlie: So this service and this support is available to everybody in the Netherlands, based on their basic health insurance requirement.
Bec: Yeah. But you don’t, you don’t have to have this service, you can choose not to have it, but nobody does. Because I, what I haven’t mentioned is, if the kraamzorg lady has already met all of those needs, so for example teaching you all the different things you need to know to be a mother, checking your health and the baby’s health, in addition to that, they do whatever else is needed in the house. So for example, they clean, vacuum, clean the toilet, bathroom, they also if you already have children, they help to look after the other child, so just keep them out of mum and dad’s way, or mum and the baby’s way, during feeding or when quiet time is needed, they look after the other child or children.
They also, if you have guests, so of course after you have a baby lots of people come around and visit and see your new baby. And, they will help serve your guests a very traditional thing in the Netherlands, I really think it is uniquely Dutch, is to have what they call beschuit met muisjes, so this is a, a dry round sort of bread biscuit, which they put butter on, and then these little aniseeds, covered in sugar. And they are made into little balls which are either blue and white or pink and white, depending on you know whether you have a boy or a girl.
So, it’s very traditional when your visitors come to serve them these biscuits. And the kraamzorg lady will also help you prepare those. One of my favourite memories of that time is she, she brought me a tropical fruit cocktail! It’s so symbolic, and it has such a, it’s such a lovely memory for me because, you know, it’s a tough time, you’re suffering from lack of sleep, and there you are sitting up in bed, and this wonderful lady who’s really like an angel walks through the door…
Carlie: With your non-alcoholic cocktail! (laughs)
Bec: …the most delicious, yeah, it’s not alcoholic, tropical fruit, tropical fruit cocktail. It was so nice that the next day (laughs) Mark actually asked her and said, Rebecca actually really loved that tropical fruit cocktail, do you think you could make her another one? (laughs) So, not, not alcoholic, it’s just literally cut up fruit with some fruit juice over it, and, very nice!
Carlie: That sounds so lovely, and so where does your doula fit in post-birth? You have this amazing support through your health insurance, you opted for a doula to help you before you gave birth, do, are they out of the picture after you have your baby?
Bec: She came and visited me after I had the baby, and we did a, a whole sort of post-birth conversation. So, it sort of helps to put the whole, all of the events into order. She helps to establish what you think and feel about the birth, if there were any thing, parts that you weren’t happy with, she sort of supports you in, in dealing with those. For me, everything went fairly well. But I can see that if things had, had not gone so smoothly, that could be really helpful, just to help you deal with it, I mean it’s such a huge event in your life, and that support was really great.
On the day of the birth, normally you would just call your midwife and say, I’m gone into labour, please come. But I, I called two people obviously, I called the doula, and I called the midwife. And my doula actually arrived first, and she was really helping me and guiding, guiding me, and the midwife therefore took a step back. And I know for this particular midwife that was a little bit hard, because this is not a typical thing in the Netherlands, to have a doula, although they are becoming more popular, I understand, right around the world, but definitely in the Netherlands.
At the hospital as well, all the early hours I spent with my doula rather than the midwife, and then a midwife took over. Because I needed to have, yeah, a certain procedure during the birth, if things get too difficult or technical, the care actually gets handed over to the hospital, which is what happened in my situation. The hospital midwife had to take over. In the end she was the most incredible woman, and she spoke the most perfect English, so in the end a doula wasn’t actually necessary. I think I would have managed just fine without one, but more than anything what that did for me was make me feel confident and calm in all the months leading up to the birth, and that was really priceless.
Carlie: Is there any conflict there, or any courtesies, like should you tell your midwife in the Netherlands that you have a doula when you first fall pregnant? Is there any etiquette that stops any conflict later?
Bec: I don’t think there’s any sort of written rules or, or etiquette, but I certainly told them right from the beginning, look I’ve, I’ve asked also for a doula to attend the birth. And the doula also very much knows her position in the situation. So anything medical is done by the midwife. The doula would just there, therefore be on the side, you know maybe even hold your hand or, or be a support point. Birth doesn’t, for some people it happens very quickly and other people it takes much longer. All of those hours that lead up to birth, the midwife doesn’t need to be sitting right next to you or holding your hand or saying kind words or just, for me what was important just eye contact, the doula was incredibly supportive just in terms of body language and eye contact to me.
Carlie: After your first experience of giving birth in the Netherlands, what did you change, or how did your expectations change when it came to having your second child there?
Bec: So, my second son was born a year and 10 months after Sam, so his name’s Liam. By that time I had been going to Dutch class (laughs) and so language-wise I felt much more confident. But even having already gone through the experience once, I felt much more confident. So, I, I remember having a conversation with my doula, because, you know, so it was so friendly, we, we talked about the fact I was pregnant again, and she said look, even if you choose not to invite me to the birth this time, please know that I’m always there for you and I will help you, and any questions you are welcome to ask me. For my second son I decided I just wanted to do it on my own, so I chose to not have, not have her at the birth, with the same team of midwives, it all went very easily, there was no, there were no issues.
Carlie: Did you make the most of the home support again?
Bec: Yes, definitely. And this time of course I had another little boy running around, and she, she helped with him as well. Once you’ve had one baby then you know what you’re doing. So all, all of the anxiety has gone, and you’ve already learnt all of those things. Whilst it’s, every baby is different, I think that’s where the service is still valuable, because maybe your, your baby’s doing something different that your first baby didn’t do, maybe it’s got cramps, or maybe it’s suffering, I remember my first son for example had a, a weeping eye, but all the, the babies can have all these different things, and that’s where it’s great to have the support of a service like that.
You can ask those daily questions too, different things kind of pop up each day. What is interesting in the Netherlands, and you think a country that is so progressive in terms of the social support and these services, you only have three months of leave after your baby is born, and then you’re expected back at work. So I think that, that’s a big difference with other countries. You get one month off before the baby is born, and then three months off after the birth. I found that to be quite a short period of time.
Especially if you’re breastfeeding, then you ha-, go back to work. I took, you do have the option to take parental leave, and have more time off, but that’s unpaid, so that can have quite an impact. There is only one rule though that you, you can use quite a good chunk of your work time breastfeeding and expressing milk if you need to. But I, I really think that mothers need a little bit more time off with their babies in the Netherlands. So that would be my only tip (laughs) to the Dutch government! Keep the kraamzorg service, incredible, amazing, and really an example for the rest of the world, to give families the best start ever with a new baby. But wouldn’t it be nice to just have a little bit of extra time off to continue breastfeeding and, and really be there for your new baby?
Carlie: That’s it for this episode. We’ve covered six things to know about having a baby in the Netherlands. The midwife service, what to expect in terms of check-ups and scans, home birthing and putting bricks under the bed ahead of your due date, very normal! Not having pain relief. Another very normal thing. You can choose to have extra pregnancy support from a doula for example. And there’s that incredible post-birth support as well.
If you have any questions for Bec about having a baby in the Netherlands, or want to share your own experiences, head over to expatfocus.com, follow the links to our forums and Facebook groups. Remember to check out our other podcast episodes on the website. They’re also available on iTunes. And I’ll catch you next time.