Thursday, August 19, 2010

There's No Place Like Home

The learning curves of a first pregnancy are not unlike those of settling into a new country of residence (and I should know, because I’m going through both things right now). Both require the quick absorption of important knowledge, the challenging of previously held opinions and perspectives, and the letting go of the little things you take for granted in life -- the ways you think you know how things work.

Sometimes what’s at stake is relatively small and yet disproportionately inconveniencing, like the day I popped out to the grocery store for some baking soda, only to be sent off on a frustrating trek that ended in a pharmacy, where such chemicals are sold in the Netherlands. These incidents catch you off guard, whereas you anticipate the larger differences, like banking systems and mortgages.

There are clear differences between the Netherlands and the US when it comes to health care. In the Netherlands, medical coverage is paid for by the state until the age of 18, at which point every resident must purchase private insurance. But the packages are generous and affordable, and insurance companies are not allowed to deny coverage to anyone, nor charge higher premiums based on age or existing conditions. Health care Shangri-la!

And using your health insurance is as easy as obtaining it. Everyone must have a huisarts, or a family doctor, who is essentially the system gatekeeper. If you want to, say, see a physical therapist, you go to your huisarts and say, “I would like to see a physical therapist,” and he writes you a note saying indeed, you may.

That’s all. He doesn’t point you to a particular therapist—you can go anywhere in the country with that note, to any doctor or specialist you want. There’s no examination. No waiting period. No paperwork. No resistance.

For about 150 euro a month ($190), I have one of the most extensive (and expensive) policies available. Prescription drugs and alternative therapies are covered and medical procedures from intensive surgeries to drop-in ear cleanings cost me nothing.

So imagine my surprise when, upon learning I was pregnant, I asked my Dutch insurance provider what maternity care coverage I had, and the answer came: “When the baby is being born, someone is coming to your house.”

This seemed incredibly vague. I went to my huisarts and reported that I was pregnant. He asked if I was happy about it, and I said I was. “Then congratulations!” he said, and he shook my hand, grinning.

He’s a happy holistic doctor who twinkles like the crystals that crowd his office. He curled his long Dutch form back into his chair and folded his hands in his lap, nodding pleasantly. He had the manner of an uncle you may find yourself sitting next to at a wedding, whom you’ve not seen in many years, and who approves of you but isn’t sure what to say to you. It was as though he had no idea why I was coming to him with this news.

I said I would like to see an OB/GYN, and he pulled out his notepad and scribbled his permission. “Have a good pregnancy!” he called to me, waving, as I left.

I called the office of an OB/GYN -- whose name, seriously, is Dr. Lipps -- and explained to the receptionist why I was calling.

“I took a pregnancy test…,” I began, in my bad Dutch.

“And you are not pregnant?” She interrupted.

“No, no, I am pregnant, so I’d like to see the doctor,” I said.

“So you do not have problems getting a baby,” she confirmed, switching to English.

“Seemingly not.”

“You are pregnant.”


“Then you do not need a doctor.”


A second trip to the huisarts cleared things up for me. In the Netherlands, a doctor is not involved in pregnancy or labor unless there is a medical problem. And because hospitals are only for sick people, no hospital stay is factored in either.

What my health insurance covers is a midwife, and the assumption is that I will have my baby at home.

My huisarts explained that you can only deliver in the hospital if you have a medical reason for doing so, or if you pay for it yourself. And even in the hospital, it’s just you and your midwife, and a midwife cannot administer pain relief. And unless you deliver at night, you are sent home a few hours after delivery.

I’ve since learned that, due mostly to outcries of the Netherlands’ many expat residents – the city of Amsterdam alone is the adopted home of people from over 175 countries – it was recently made possible to elect to deliver in the hospital at no personal cost (although there is still no overnight stay) and to insist on an epidural in specific hospitals. But the request can only be honored if the anesthesiologist is on call and available when the time comes, and most go home at 5pm.

Now, I have had many friends over the years share their birth stories with me, and they range from the planned C-section that ensured labor didn’t mess with a busy New Yorker’s schedule to a friend who delivered, as her husband was frantically driving her to the hospital, in the front seat of her pickup truck.

Most of my friends who have become mothers had given a lot of thought to their birth plans and knew exactly what they wanted, and why. Those who wanted drugs and a hospital stay had very convincing reasons for doing so, as did those who wanted to have their babies with little or no medical intervention.

Where and how you give birth is an extremely personal decision, and I’m probably in the minority when I say it’s not one I’d ever given any real thought to making. A friend of mine from the UK recently had her first baby in the Netherlands, and she was able to insist on a hospital birth with drugs. But I’m actually embracing the home birth idea, and the more I think about it the more it appeals to me.

I am not a woman who has always visualized child birth as an empowering experience. I do not think of a labor as a “hero’s journey.” Other than a brief dabbling in my youth, mainly for the drugs, there’s nothing hippie or bohemian about me. You’d have to dig pretty deep to find my inner earth mother. The only clear idea I’ve ever formulated about child birth is that it will hurt. A lot.

But given that, why not be in the comfort of your own home, where you can be in your own bed, use your own bathroom, have all your own clothes and things around you, and feel relaxed and comfortable in a familiar environment?

And so barring any medical problems, the plan is indeed that, when the baby is being born, someone is coming to my house.

1 comment:

  1. Ok I finally got my own account logged into I hope..

    I wanted to let you know some of the info you received has changed in the past few years. It's now LAW in this country (NL) that you should be allowed access to an epidural during labor 24/7. It was the case for both my pregnancies too. I had both epidurals in the middle of the night. The dr was pulled out of his bed to come to the hospital to give it to me.

    I had to have my kids in the hospital as both were very overdue and needed to be induced (1st born 16 days over and 2nd born 8 days over).

    We did check with insurance though with 2nd as we weren't sure if she'd be overdue but wanted hospital anyhow and was it covered? It was 100% covered even if it was voluntary as we have the PLUS package with our provider. We chose that because dental is almost totally free this way even with having work done.

    We also learned from this phone call that if we didn't have the plus package, we'd have to pay something like 5 euro a day to stay in the hospital which is insanely cheap..

    If you decide you want the hospital, that is your right. I applaud you for doing it at home.. it was my plan for both kids originally and I wish you the best of luck. The midwives here as AWESOME and they will get you to a hospital in time if need be. You will be safe!

    I wish you a great rest of your pregnancy and a the birth experience you want!! (


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