Our little girl was born last week at a birthing centre in Amsterdam, and I just wanted to document my very positive Dutch birth experience while it's still fresh. Best of luck to all my friends who are delivering in the coming months! It's a baby boom!
The Dutch way
The Netherlands is all about natural childbirth, and ex-pats in Holland spread horror stories about pain relief being illegal, home births required by law unless there is a medical indication, and being given only paracetemol (tylenol) to women recovering from c-sections.
There is some truth to this, but these days expecting parents have more choices for their childbirth in The Netherlands than anywhere else in the world. The whole birthing process is lead by midwives, and you can choose to give birth at home, in a birthing centre, or in a hospital (though if there are no medical reasons for a hospital birth, you have to pay a hefty premium to your health insurer), if you've had a c-section, you can try to deliver "naturally" on future children (though only if it is deemed entirely safe), and there are choices for pain relief (though you must be in a birthing centre or a hospital, even for simple pain relief like laughing gas or remifentanil).
And, most importantly, in The Netherlands you get a trained "maternity care giver" -- think "professional mother" -- who comes to your house for 8-10 days after birth to train you with the Dutch system of raising babies.
Labour
I was one week late, my husband had just wrapped up all his projects at work, handed in his thesis proposal at school, and had his last class the day before. I had just finished the baby blanket and hat -- the last of my pre-baby maternity leave projects. We went for a date, dinner and a (very violent) movie, and came home to watch comedies to lighten the atmosphere.
Just as we were showering before bed, my contractions started around 2AM, were straight away 6-8 minutes apart, and almost immediately my water broke. There was clearly meconium in the water (which meant we had to go to the hospital), and the midwife came to our house to confirm this diagnosis.
The Dutch way
The Netherlands is all about natural childbirth, and ex-pats in Holland spread horror stories about pain relief being illegal, home births required by law unless there is a medical indication, and being given only paracetemol (tylenol) to women recovering from c-sections.
There is some truth to this, but these days expecting parents have more choices for their childbirth in The Netherlands than anywhere else in the world. The whole birthing process is lead by midwives, and you can choose to give birth at home, in a birthing centre, or in a hospital (though if there are no medical reasons for a hospital birth, you have to pay a hefty premium to your health insurer), if you've had a c-section, you can try to deliver "naturally" on future children (though only if it is deemed entirely safe), and there are choices for pain relief (though you must be in a birthing centre or a hospital, even for simple pain relief like laughing gas or remifentanil).
And, most importantly, in The Netherlands you get a trained "maternity care giver" -- think "professional mother" -- who comes to your house for 8-10 days after birth to train you with the Dutch system of raising babies.
Labour
I was one week late, my husband had just wrapped up all his projects at work, handed in his thesis proposal at school, and had his last class the day before. I had just finished the baby blanket and hat -- the last of my pre-baby maternity leave projects. We went for a date, dinner and a (very violent) movie, and came home to watch comedies to lighten the atmosphere.
Just as we were showering before bed, my contractions started around 2AM, were straight away 6-8 minutes apart, and almost immediately my water broke. There was clearly meconium in the water (which meant we had to go to the hospital), and the midwife came to our house to confirm this diagnosis.
I was quite relieved that we had a medical indication that forced us into a hospital birth. For months I had been making an ambiguous response to the question "Are you planning on having a home birth?" Natural childbirth at home just sounds so romantic, and is so valued in The Netherlands. Imagining candles, soft music, and an intense peacefulness in our loving home.
- Are you sure you want to be open to a home birth? There's a lot of blood and stuff. Which room / piece of furniture are you imagining giving birth on?
- Yah, I feel like I'd be more comfortable in a hospital, but we also live on the fourth floor in a building with steep stairs and no lift. Do you want to carry me downstairs in full labour? Home birth may seem like a really good option then.
The midwife made all the arrangements with the birthing centre attached to the Saint Lucas Andreas hospital in Amsterdam, and drove us there. It was such a smooth process, timing our movements between my contractions. When we arrived at the hospital, we just walked straight through into our private room, no hassles, no paperwork, no waiting. The birthing centre rooms are spacious, you have your own bathroom with shower, bath, and toilet.
My husband managed communication with the midwives, students, and nurses, and I managed my pain. My tactic to withstand the contractions was that he would pinch both of my Achilles tendons (an acupressure technique recommended by a work colleague), and I would focus on that pain and my breathing. This really kept me in "the zone", and enabled me to keep it together (I only had to ask my husband once to "Please stop talking" -- use of the word "please" constitutes "keeping it together" in my books). I spent most of my labour laying on my side with a big pillow between my knees, enjoying the spaces between the contractions as much as possible. I probably should have moved around more to speed up my contractions, but I was far too content laying on my side.
Almost immediately they ran tests to make sure the baby was not in distress (though I was never doubted it, I just knew the baby was fine), and after a short time we had the results: we were not in the unlucky 10% of cases where meconium is a serious indication, our baby was in great condition.
After about 5 hours of labour, I was nearing dilation but my contractions were still only 5 minutes apart. They explained that it was important my contractions were a minimum of 2 minutes apart before we could push the baby through the birth canal, because if something were wrong 5 minutes was too long to wait between pushes. They gave me oxytocin to speed up the contractions, at which point I also requested remifentanil -- with all the tubes and elastic bands I was hooked up to, it was one more that would actually make me feel good! I didn't find that the remifentanil did anything to lessen the intensity of the contractions, but they made the spaces between contractions even more enjoyable.
- Are you sure you would like remifentanil?
The midwife made all the arrangements with the birthing centre attached to the Saint Lucas Andreas hospital in Amsterdam, and drove us there. It was such a smooth process, timing our movements between my contractions. When we arrived at the hospital, we just walked straight through into our private room, no hassles, no paperwork, no waiting. The birthing centre rooms are spacious, you have your own bathroom with shower, bath, and toilet.
My husband managed communication with the midwives, students, and nurses, and I managed my pain. My tactic to withstand the contractions was that he would pinch both of my Achilles tendons (an acupressure technique recommended by a work colleague), and I would focus on that pain and my breathing. This really kept me in "the zone", and enabled me to keep it together (I only had to ask my husband once to "Please stop talking" -- use of the word "please" constitutes "keeping it together" in my books). I spent most of my labour laying on my side with a big pillow between my knees, enjoying the spaces between the contractions as much as possible. I probably should have moved around more to speed up my contractions, but I was far too content laying on my side.
Almost immediately they ran tests to make sure the baby was not in distress (though I was never doubted it, I just knew the baby was fine), and after a short time we had the results: we were not in the unlucky 10% of cases where meconium is a serious indication, our baby was in great condition.
After about 5 hours of labour, I was nearing dilation but my contractions were still only 5 minutes apart. They explained that it was important my contractions were a minimum of 2 minutes apart before we could push the baby through the birth canal, because if something were wrong 5 minutes was too long to wait between pushes. They gave me oxytocin to speed up the contractions, at which point I also requested remifentanil -- with all the tubes and elastic bands I was hooked up to, it was one more that would actually make me feel good! I didn't find that the remifentanil did anything to lessen the intensity of the contractions, but they made the spaces between contractions even more enjoyable.
- Are you sure you would like remifentanil?
- I wouldn't be asking for it unless I was at my wit's end. Yes.
- Can you wait 10 minutes and then decide if you would like it?
- It will take you 10 minutes to set it up, so no, I don't want to wait an additional 10 minutes.
- Wait 10 minutes, then press this red button and we will start you on remifentanil.
[9 minutes later...]
- Do you still want remifentanil?
- I wanted remifentanil 10 minutes ago...OF COURSE! YES!
After the labour was over and I had my little girl in my arms they asked me if I was glad that they made me wait 10 minutes. I was far too tired to deliver a collected and calculated response which somehow articulated the depth of my displeasure with them, that the unnecessary and non-medical postponement of remifentanil was the only major disappointment I had in my entire labour experience, and that it explicitly states in my birth plan that if I ask for pain relief, I am to be taken seriously with immediate action because I tend to push my body beyond its capabilities.
- No.
Once the contractions were every two minutes (and I was already involuntarily pushing during contractions), we started the pushing phase. After 5 minutes, they said I would need an episiotomy because the baby was showing signs of distress (but again, I was not worried about it). I didn't really feel anything, and then we resumed pushing and within about 5-10 minutes I had a beautiful slimy baby placed directly from my womb onto my chest.
Although I could feel everything (the remifentanil is only used for a short window before the pushing phase, and leaves your system within 4 minutes), I almost couldn't believe that this little creature on my chest was our baby. All I could see was this little head, which shielded the rest of her body from my sight.
We waited 15-30 minutes or so for pulsations to cease, and then my husband cut the umbilical chord. She breastfed within the hour, and as soon as I was stitched up, everyone cleared the room and left us alone with with our baby for two glorious hours -- she was alert, calm, and such a delight for us. A while later they came with food and champagne for us. Eventually they weighed the baby with my husband (the elation of birth started to be replaced by the exhaustion of labour, and I spent the rest of the day laying down), and we were released.
Maternity care
We walked out of the hospital 5 hours after our baby was born, and a maternity care giver (in Dutch, a "Kraamverzorgster") was at our house within an hour of arriving home to help us settle in. This is something which I think is exclusive to The Netherlands. All new parents and babies are cared for in your own home by a maternity nurse / care giver for the first 8-10 days of your baby's life. The maternity care givers provide daily checkups to the baby and mother, assist with breastfeeding, diapers, cook, clean, fetch groceries, let you sleep, shower, and provide daily (Dutch) parenting tips.
- Can you wait 10 minutes and then decide if you would like it?
- It will take you 10 minutes to set it up, so no, I don't want to wait an additional 10 minutes.
- Wait 10 minutes, then press this red button and we will start you on remifentanil.
[9 minutes later...]
- Do you still want remifentanil?
- I wanted remifentanil 10 minutes ago...OF COURSE! YES!
After the labour was over and I had my little girl in my arms they asked me if I was glad that they made me wait 10 minutes. I was far too tired to deliver a collected and calculated response which somehow articulated the depth of my displeasure with them, that the unnecessary and non-medical postponement of remifentanil was the only major disappointment I had in my entire labour experience, and that it explicitly states in my birth plan that if I ask for pain relief, I am to be taken seriously with immediate action because I tend to push my body beyond its capabilities.
- No.
Once the contractions were every two minutes (and I was already involuntarily pushing during contractions), we started the pushing phase. After 5 minutes, they said I would need an episiotomy because the baby was showing signs of distress (but again, I was not worried about it). I didn't really feel anything, and then we resumed pushing and within about 5-10 minutes I had a beautiful slimy baby placed directly from my womb onto my chest.
Although I could feel everything (the remifentanil is only used for a short window before the pushing phase, and leaves your system within 4 minutes), I almost couldn't believe that this little creature on my chest was our baby. All I could see was this little head, which shielded the rest of her body from my sight.
We waited 15-30 minutes or so for pulsations to cease, and then my husband cut the umbilical chord. She breastfed within the hour, and as soon as I was stitched up, everyone cleared the room and left us alone with with our baby for two glorious hours -- she was alert, calm, and such a delight for us. A while later they came with food and champagne for us. Eventually they weighed the baby with my husband (the elation of birth started to be replaced by the exhaustion of labour, and I spent the rest of the day laying down), and we were released.
Maternity care
We walked out of the hospital 5 hours after our baby was born, and a maternity care giver (in Dutch, a "Kraamverzorgster") was at our house within an hour of arriving home to help us settle in. This is something which I think is exclusive to The Netherlands. All new parents and babies are cared for in your own home by a maternity nurse / care giver for the first 8-10 days of your baby's life. The maternity care givers provide daily checkups to the baby and mother, assist with breastfeeding, diapers, cook, clean, fetch groceries, let you sleep, shower, and provide daily (Dutch) parenting tips.
24 hours of bliss
The first 24 hours, the baby doesn't really need to eat much, and it was such a blissful and joyful time for us to spend with our calm and happy baby before the feeding pressure started the next day.
