Pregnancy, birth and child care in the Netherlands

A colleague sent out an email to those of us at the office who have recently had kids, asking for information and input for a friend about living in the Netherlands, especially with regard to having a baby and raising a child here. In true Krees fashion, I sent her a treatise. Then I realized that all the information (with a little opinion) might be useful to others. So here it is.

The Dutch view of pregnancy is that it's a natural part of life and shouldn't be interfered with too much from a medical perspective. I believe(*) that if you have a normal, healthy pregnancy, your prenatal visits are with your local doctor / general practitioner called the "huisarts", and not with an obstetrician or gynaecologist. I don't happen to know how frequent the visits are or how many ultrasounds are routinely given. (*We had complications getting pregnant, so I was able to get a referral to the ob/gyn department of the local hospital and have had all monthly prenatal check-ups there, including an ultrasound at nearly every visit. Toward the end of my first pregnancy they saw me more frequently.)

30% of Dutch women still give birth at home with the assistance of a midwife and huisarts. This is probably more common and available in larger cities. Both of my pregnancies have been in small villages where there are not enough births to keep the huisarts very practiced with birthing. I've been required to deliver in a hospital, which is fine with me.

Maternity matters - What to expect in the Netherlands
http://www.expatica.com/nl/family/kids/Maternity-matters-_-What-to-expect-in-the-Netherlands_11936.html

Because of the tradition of giving birth at home with a midwife, it's also not common to use epidurals or other pain meds during labor and delivery here. Most Dutch mothers give birth without it. Even though I was in a hospital for my first delivery in 2007,  I don't think I would have had the option of getting an epidural because it was the middle of the night and there may not have been an anesthesiologist available. (Personally, my preference was to give birth without meds, and fortunately I had a fairly easy delivery. But should it have been more difficult, I think I would have liked to have had the option available!)

I believe the government now requires hospitals to be able to provide pain meds to birthing mothers who want it. The article I read, however, says this is in the "guidelines" - which doesn't sound like law to me:

Epidurals now standard practice in Dutch hospitals
http://www.expatica.com/nl/news/local_news/Epidurals-now-standard-practice-in-Dutch-hospitals.html

If you do give birth in the hospital and there are no complications, you can expect to be discharged in just a few hours. However, your health insurance covers the cost of "kraamzorg". This is post-natal care provided by a professional nurse(?) who comes to your house every day for the first week to make sure that you and the baby are both doing well, that you're able to breastfeed successfully if you so choose (the Dutch are big on breastfeeding!), and also to help with a few chores like changing the bedsheets, cleaning the bathrooms and doing laundry so that you can get some extra rest!

Kraamzorg - Postnatal Care in the Netherlands
http://www.expatica.com/nl/family/kids/Kraamzorg-_-Postnatal-Care-in-the-Netherlands_13313.html


I have a higher level of health insurance which, as Charles said, has covered almost everything, including doctor's visits, regular ultrasounds, blood tests, labor/delivery and "kraamzorg" care. The only pregnancy-related costs have been for a couple special ultrasounds to check for indications of birth defects. I imagine the basic level of health care would cover the same, but human resources should be able to tell you.

Charles mentioned the amount of maternity leave (4 weeks before your due date, 12 weeks after birth, all paid at your full rate, plus [our institute] gets money to pay for your replacement while you're on leave). I don't know if this is standard government-required leave or if it's specific to [institute]. And he was right that if you choose to breastfeed, they are obligated to provide a private place for you to pump. I think most Dutch women stop at three months when they return to work, but I was able to continue for 12 months after returning to work.

I think it's easier to find childcare where we live than in some other parts of the country. (It's WAY easier than in Germany where I understand it's nearly impossible to find daycare.) There are "kinderopvang" creches where your child goes to a nursery with lots of other children, and there are also providers (an "oppas")  who take children into their homes.

The government gives you money toward childcare. In our case (my husband works full-time, I work half-time), we get something like 400+ euros/month which covers about 80% of the daycare cost. Last year the government discovered that they had REALLY underestimated the amount of money they would be paying out for this daycare subsidy. I thought we would see our reimbursement drastically cut this year, but I don't think they've cut it at all.

A short guide to childcare in Holland (Expatica)

Day-care costs through the roof (Expatica, 26 March 2008)

Cuts in child care subsidies unite opposition (Expatica, 9 September 2008)

There are also options for returning to work part-time for nearly full-pay during the first year for both mother and father.

All in all, the Netherlands is a pretty good, safe place to give birth, and it's definitely a good/supportive place to raise a child. But as Charles mentioned, society here is also really more oriented toward women working part-time rather than full-time (in my opinion). Shops and banks regularly close at 6pm or earlier, are often closed Monday mornings and at lunchtime, and are closed completely on Sundays. I don't know how a family with two full-time workers (or even single, full-time workers) do it. I guess that's why employees get so much vacation time - so we can do our banking and trips to the druggist!

More info available at:
I amsterdam - Family and Health articles
http://www.iamsterdam.com/en/living/familyandhealth

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Since writing this up, there have been a couple additional news items that may be of interest:

Home births as safe as hospitals
http://www.dutchnews.nl/news/archives/2009/04/home_births_as_safe_as_hospita.php

Dutch children's wellbeing best in Europe
http://www.dutchnews.nl/news/archives/2009/04/dutch_childrens_wellbeing_best.php

Comments

[Aleid]

A few additions if you do not mind: When you deliver with just the midwife (and also have your checks with her), you see your midwife every month for the first 7 months, then every forthnight for a month and weekly in the last month. You get at least 2 ultrasounds (9 and 20 weeks)but more if necessary. Also I was told (although I delivered in an academic hospital) I could always have pain meds - fortunate I did not require one...
Also the materinity leave is the same (16 weeks in total) all over the NL, so that is not institution bound, whether you get reimbused parental leave that is different by insititution. Furthermore, next to the private room for extracting when breastfeeding, you are also allowed (during your breastfeeding period) to do so for 2 hours a day at work - full pay. Which - in my case - was transformed to cycling up and down to the nursery to feed Duko, because I hated extracting and this gave me some much-needed exercise as well...

Good job -- getting ready for nr. 2?

[Krees]

Great info! Thanks, Aleid.

We're not yet getting ready as much as we probably ought to be. We're still discussing names, and I haven't yet picked up my birthing book for that necessary refresher. +/-7 weeks to go!

[Child Therapy]

I've being researching about Child care and reading your blog, I found your post very helpful :) . I thought I would leave my first comment. I don't know what to say except that I have enjoyed reading. Nice blog!

[Stilkwood]

Hi Aleid, thanks for the blog. I would go to NL for a long term staying with my family. I have got a good idea reading your blogs about various stages. I would really liked to discuss this with my wife, as we are planning to have kids, and at that time I might be in NL. Just for information, Could you please tell me an estimate of how much it may cost in Pregnancy, and Post Pregnancy period as I have completely no idea of that, also this is missing in the blogs I've read. It would be a GREAT help for me if I know before I plan something.

Happy Motherhood!!!

Rgds,
Stilkwood

[Katerina]

Hey,

Dutch are very much for natural birth, the simple reason for it-it is cheap! During pregnancy woman recieves minimum of analysis, just 2 ultrasond and two blood tests. At the rest of the appointments all that midwife does, just touchs the bally and hears the heart beat. The cost of pregnancy is about 3000 euros, but most of this covered by insurance, which everyone in NL have to have. However, if you not medically prescribed to have birth in the hospital, you would have to pay it by yourself. It happens often that woman started to deliver at home, still in the middle of labor due to difficulties arose, have to go to the hospital. Of course with this approach it is not a strange thing that NL is on the first place with child and maternity death rate between EU countries. I personally decided not to have birth here and to for delivery to Germany.

Greets!

[tumor cells]

It is unusual even in Netherlands are given many home births because this represents a risk to the mother and child

[Buy Viagra]

The kids in every country are a blessing form above the problem is that to have a kid is very expensive and if you have 3 or 4 will be terrible to every one .

[Mick]

I live in the Netherlands. My first child was born at home and my second in the hospital. I really prefer the homebirth! I was in the safety off my own home, I could walk around, take a shower etc... Everything was very relaxed. I really feel this helped a lot; I had a fairly easy delivery only 5 hours... Offcourse there was pain but it was over soon and then there was my son!
Next delivery in the hospital was VERY different. Bright light, a lot off people walking in and out off the room, being stuck to a machine... I hated it. And I was very happy to go home a few hours after his birth

[Aziz Sheikh]

Can someone please help me with the information for Netherlands.

1. How many % of women do the pregnancy tets:

2. How many times Pregnant women do the Ultrasound screening. (Before 12 weeks: after 12 weeks: )

3. Cost of one ultrasound screening/test ( transvaginal : Transabdominal: )

4. Cost of baby delivery at government hospital (Normal Delivery: Cesarian Delivery: )

5. Cost of baby delivery at private hospital (Normal Delivery: Cesarian Delivery: )

6. How much is the Government allowances for per baby birth:

7. Insurance coverage;