I am pregnant and will be giving birth in the Netherlands. What practical preparations do I need to make?
The Dutch philosophy is that childbirth is a natural, physical process, not a medical condition. Prenatal care is usually provided by a verloskundige (midwife). The role of the doctor or gynaecologist in a normal pregnancy in the Netherlands is minor and in most cases they do not get involved at all, unless there are complications. Therefore, the first priority is to find a midwife. It is best to register with your midwife by week 8-10 or as soon as you arrive in the Netherlands.
You can search the online ‘Yellow Pages’ (in Dutch only), under ‘verloskundigenpraktijk’ or talk to your huisarts (GP) – he/she will be able to point you in the right direction.
There are a few other things that you should consider:
- Make sure you know what your health insurance covers for you
- Register yourself with a kraamzorg (postnatal maternity care) agency, preferably before week 12 of your pregnancy. Your midwife can direct you to organisations that they partner with and your health insurance provider must be contacted to ensure your chosen maternity care agency or ‘so-called’ kraamcentrum is approved by them
- Decide where you want your baby delivered. The Dutch are big believers in home births, so make it clear if you want to give birth in a hospital. You have the flexibility of changing your mind at the last minute if you decide to go for a home birth
In addition to midwife visits, it may also be advisable for you to consider attending a childbirth preparation class. ACCESS offers this kind of courses in The Hague, Amsterdam, Rotterdam, Utrecht or, if preferred, on online mode. Visit the ACCESS website for further information.
Will my Dutch health insurance cover childbirth costs if I am already pregnant when I move to the Netherlands?
Maternity care is covered by basic insurance and pregnancy is covered even if it is a pre-existing medical condition.
If you have just moved to the Netherlands and have applied for health insurance, it might take some time before you are insured. In that case, it is still possible to see a midwife. You will probably have to pay for the visit. If the appointment is on or after the starting date of your insurance, the costs will be reimbursed as soon as you receive your insurance number.
If a hospital birth is for a medical reason (i.e. you have been referred to secondary care), your medical insurance company will normally cover the total costs. Choosing a hospital birth when there is no medical indication incurs a personal contribution of around €320. Some medical insurance policies cover these costs – check your own medical insurance to establish exactly which costs are covered.
Can you please tell me what services I can expect from a midwife?
In the Netherlands, maternity care is organised in a so-called ‘primary, secondary and tertiary care model’. Primary care, for low-risk women, is usually performed by verloskundigen (midwives) and huisarten (GPs), where GPs are responsible for only about 0.5% of all births. Secondary care consists of obstetricians and specialised ‘clinical’ midwives in general hospitals and tertiary care comprises obstetricians in specialist academic hospitals.
Hence, midwives in the Netherlands are the lead medical professionals for providing care to women with ‘normal’ or uncomplicated pregnancies. They are independent practitioners (like GPs) and can work independently in a private midwifery practice or as part of a group.
After registering with a midwife, you will initially receive a check-up once a month. As the pregnancy progresses, the midwife will want to see you more frequently. In case of complications or an increased risk of complications during pregnancy, labour or in the postpartum period, the midwife will refer her client to a obstetrician who will take over responsibility.
As an independent practitioner, a midwife can legally practice obstetrics without the supervision of a medical doctor. She is the sole healthcare provider during pregnancy, labour, delivery and the initial postpartum (postnatal) period. In short, she will help ensure that you and your baby are safe during pregnancy and through to delivery. Among other things, you can expect a midwife to:
- Record you and your partner’s medical history, as well as that of your extended family
- Monitor your weight and blood pressure, the foetal growth, position and heart beat
- Check your blood iron levels
- Discuss with you plans about delivery, i.e. whether you plan to give birth at home or in an outpatient clinic (hospital or birth centre)
- Assist you during labour, delivery and the initial post-partum period
Please note that you do not need a referral from your GP. You will find midwives listed on the Yellow Pages (in Dutch only). Alternatively, you can talk to your huisarts (GP) – he/she will be able to help you finding one in your local area.
It is reassuring to know that you can always change your midwife during your pregnancy if it does not click, or you feel that your birth plan cannot be carried out as you want.
Most of women’s obstetrical care is also provided by a obstetrician, if there are medical reasons for it, even fairly simple ones. In that case, the midwife will refer you to the obstetrician who will supervise all phases of care and the delivery will take place in a hospital. If there is no medical reason to have a hospital birth, please be aware that extra costs may incur.
How can I find a native English-speaking midwife?
Most midwives in the Netherlands have a good command of the English language. Your huisarts (GP) should be able to refer you to an English-speaking midwife, so please do not hesitate to ask him/her for a referral or recommendation. We also suggest that you visit the English pages of the Royal Netherlands Organisation of Midwives website.
Which prenatal tests are usually carried out in the Netherlands?
In the case of a low-risk pregnancy, you will be offered two ultrasound scans: one in the first term or trimester (0-13 weeks) to determine a due date and one anomaly scan at twenty weeks. There needs to be a medical reason to have additional ultrasound scans. The scans are sometimes made by the midwife herself in her own practice; otherwise you will be referred to a primary care ultrasound centre.
A prenatal screening test looks for pointers for certain conditions and assesses your risk against the baseline national average risk of having a baby with certain abnormalities. Women are normally offered a combination test, which calculates her risk of being pregnant with a Down (trisomy 21), Edward’s (trisomy 18) or Patau’s (patausyndroom) (trisomy 13) syndrome baby. The test is a combination of two separate tests:
- A blood test which is conducted at between 9-13 weeks of pregnancy. The test is used to detect the level of two proteins in your blood which can be a pointer of Down syndrome
- An ultrasound is undertaken between 11-14 weeks of pregnancy, where the nuchal fold will be measured. The nuchal fold is a layer of fluid at back of the neck of the baby. A thickness greater than average layer is a possible indicator that the baby may have Down syndrome
The combination test performed on women younger than 36 years of age is not normally covered by medical insurance, so you are advised to check with your insurance company first.
If it is determined that you have an increased risk of Down syndrome after doing a screening test, you will be offered a NIPT test. Non-Invasive-Prenatal-Testing (NIPT) is a new prenatal screening test, which has been introduced relatively recently in the Netherlands. A blood sample is taken from the pregnant woman and used to test whether the unborn child may have trisomy 21, trisomy 18 or trisomy 13. Whilst this test cannot guarantee 100% accuracy, it will give a good indication if further diagnostic tests are necessary.
For more information about the costs of these tests, we suggest that you consult this website (in Dutch only) linked to the Ministry of Health, Welfare and Sport (Ministerie van Volksgezondheid, Welzijn en Sport).
Should I follow a prenatal course?
Prenatal courses are organised to educate expectant women and their partners in the preparation for labour, offering you tools to manage your labour pain, optimal positions for birth, tips for recovery after birth and how to be a new mother. They usually last between 4 to 8 weeks and are often followed by a postnatal reunion. It is recommended to register by week 16, as the classes can often fill up very quickly.
Obviously, any prenatal course you attend provides you with the opportunity to meet other expectant mothers or couples, but the class you choose and how helpful it turns out to be once labour starts may depend on your knowledge of the language (courses will be available mainly in Dutch but also in English). Therefore, it is important that you choose a prenatal course carefully.
In larger Dutch cities, you can find prenatal courses offered especially for expats. ACCESS also offers childbirth preparation courses in various cities. These courses are tailored specifically to the expat community and are conducted in English. The courses provide an informative practical insight into pregnancy, childbirth, postpartum and breastfeeding and explain how the Dutch healthcare system works. The courses also have the added advantage that you are able to meet other international couples.
If you want to take part in the course, you need to be in your third trimester, i.e. be at least 26 weeks pregnant. ACCESS-run childbirth preparation courses can be booked on the ACCESS website through the this link. Alternatively, if you wish to find a prenatal course in your area, you can ask the ACCESS Helpdesk to locate one nearest to you.
Where can I learn more about breastfeeding?
A good place to start is to contact your kraamcentrum (maternity care agency) as many of them have lactation specialists and offer their own breastfeeding courses for expectant mothers. They will also be there to offer support and advice during the first week of your baby’s life. To find your nearest maternity care agency, please look at the list provided on the ‘kraamcentruum’ tab on the official kraamzorg website (in Dutch only).
One of the best ways to look for breastfeeding courses is to find an English speaking lactation consultant in your area. They are the specialist in breastfeeding issues, and they often also give group courses or individual sessions. Alternatively, ask your midwife if she/he knows any English-speaking breastfeeding courses in your area.
Amsterdam Mamas website provides with a list of specialists and consultants related to lactation and other useful information.
If you have any questions or problems, you can also visit the website of the Cooperating Breastfeeding Organisations (Samenwerkende Borstvoeding Organisaties – SBA): Borstvoeding.nl (in Dutch only). Here you can find links to the five main organisations involved in protecting, promoting and supporting breastfeeding in the Netherlands, as well as a tool to locate breastfeeding cafés near you.