Pregnancy in the Netherlands: Home or hospital?

This next installment took me a while to write. There’s so much to process! I also stumbled upon what seems to be a hot debate between hospital and home births, and it rattled me a bit. Let me say that I’m not taking sides on a big debate, but simply trying to make a personal decision about what I believe will be best for me and my baby.

So, giving birth in the Netherlands will come in two parts—how the system works, and how I made my choice. Later on, of course, there will be an epilogue: my actual birth story!

With the highest rate of home births in the industrialized world, it seems the Netherlands is the land of home births. Early on, I thought everyone gave birth at home. The Dutch seem proud of this fact, and I could definitely see it being a point of pride among the strong, sturdy Dutch superwomen.

In reality, 75% of Dutch babies are born at a hospital. Still, a 25% home birth rate is way higher than in neighboring countries—for example, just across the pond, the U.K. has a 2.7% rate for home births.

After a home birth (1948). Photo by Ad Windig, from the Amsterdam City Archives

After a home birth (1948). Photo by Ad Windig, from the Amsterdam City Archives

I get a “go directly to hospital” card if my pregnancy or labor “goes medical”—meaning factors that require medical intervention come into play, such as preterm labor, gestational diabetes, pre-eclampsia or a host of other possible scenarios (even uber-itchy feet, as in the case of this Amsterdam-based Pinay mom). Insurance will fully cover the cost of the hospital birth if this happens.

I also go to a hospital if I want any kind of pain relief, such as an epidural. This is because midwives, not being doctors or anesthesiologists, aren’t licensed to administer anesthetics. (This makes me think that an anesthesiologist who does house calls could make a killing in Amsterdam.) In this case, my insurance will only cover part of the cost.

Otherwise, where I give birth is my choice. The Dutch culture won’t push me into having a home birth; it’s simply that if I want a home birth, there’s a well-oiled system in place that could let me have it. So in my fourth or fifth month, I began to look into the reasons why I might actually want it.

When I asked my midwife about home births, what she said was so (quite Dutchly) simple and matter-of-fact, it stuck with me. “You begin labor at home,” she said. “If you can finish at home, then we finish at home. If you want to go to a hospital, then we go to a hospital.” Simple as that.

I almost felt like: “Duh! Of course! Why didn’t I think of that?” (By this time I’d been living here for a year and a half, so this made perfect sense to me.)

She also told me women who prefer to give birth at home do so because it’s where they feel the most comfortable, cared for and relaxed. Early on, I thought the idea of being relaxed was overrated, almost a luxury, and that nothing could be more comforting than being surrounded by white coats.

But as I read and heard more birth stories, I realized that real labor is not like the movies (water breaks, woman screams, and a few cinematic cuts later, the baby is born). Early labor can take a long, long while.

So I began to picture early labor at home. Marlon can cook, we can watch Top Chef, I can get into a bubble bath and curl up in my own bed with my own blankets, pillows, and cat. Compared to pacing a cold hospital hallway until I dilate, or sharing a ward with three to six other women, this actually sounds really… nice.

That’s because (and this is where the Netherlands differs so vastly from home) you can’t throw money at the system and expect special treatment. Here, hospitals don’t cater to the income inequality we have back home. You can’t drop an immense wad of cash and be assured the luxe pampering of, say, the Asian Hospital; in fact, depending on the hospital’s capacity, you may not even get your own room to moan and groan in.

Babies born at the Sint Clara hospital, Rotterdam. Photo by Kees Scheerer, from the Amsterdam City Archives.

Babies born at the Sint Clara hospital, Rotterdam. Photo by Kees Scheerer, from the Amsterdam City Archives.

Also, being relaxed and comfortable during labor is not a selfish thing. Calm and security plays a role in production of oxytocin, called the “love hormone” because it comes from feel-good experiences like love and sex. Oxytocin is an important hormone for labor: it stimulates contractions which help dilate the cervix, and moves the baby out of the uterus and birth canal, and helps minimize bleeding after the placenta is expelled. Low oxytocin can prolong labor, which is why women whose labor has stalled are given a synthetic version called Pitocin.

Of course, it won’t be all cuddling and candlelight when early labor turns into active (read: painful) labor. At that point, I can stay home and manage the pain naturally, or ask (probably scream at) my midwife to take me to the hospital. This is when she calls the hospital and arranges a transfer. The hospital’s team of midwives and nurses takes over, and she leaves me to their care.

Extra Challenge round: there may not be a place for me at my hospital of choice! The midwife must then call each of the six hospitals in Amsterdam (and, if it’s a really busy time for births, maybe even the neighboring town of Amstelveen) until she finds a place for me.

Still, it’s not as freaky as it sounds. It’s just 12 minutes to Sint Lucas Andreas, my preferred hospital and the one closest to me, and just 17 minutes to the Slotervaart Ziekenhuis and the VU Medisch Centrum.

Also, depending on how labor goes, there simply might not be enough time for a transfer… or I might not even want to leave the house. This happened to a friend who was determined to give birth at a hospital, but lived on the fourth floor and did not want to negotiate the Dutch stairs of doom once contractions began. She gave birth in her bathtub after an amazingly short labor.

So, while a hospital birth is not out of the realm of possibility, it helps to be mentally prepared for a home birth. And you know what? I think I am.