Box of Tricks

I recently spent the afternoon with a friend I’ve known since high school, a whopping 19 years. She has a five-year-old son whom she delivered at her home in a nearby town, and while she drank a goblet of wine that I eyed longingly from the rim of my water glass, she told me her birth story.

She said she first felt contractions around 1 am, and managed to sleep through them until about six the next morning, when she sank into the couch and watched television until they became stronger and closer together, at which time she called the midwife.

The midwife arrived on her bicycle, birthing stool in hand, and within two hours my friend’s son had arrived, the house had been cleaned, and the midwife had left. My friend’s recollections were all positive. The labor was quick, she said, and didn’t hurt so much as it “was uncomfortable.”

Stories like hers are always reassuring. It helps to think that someday I’ll (knock wood) be on the other side with my own happy, healthy home birth story. But then one thing she had said echoed back: the midwife had left. She left? She just left? You have a baby and then midwife just hops on her bike and leaves you there, in your house, alone with a new baby?

Of course this should have dawned on me before. The fact that I am not going to be staying in the hospital means I will not have a staff of nurses looking after me and my new bundle throughout the first night. But I had somehow not envisioned giving birth and then being left to my own devices with a baby in my house. I know nothing about babies.

My friend reassured me: the midwife will leave, yes, but the next day, the kraamzorg will arrive.

Kraamzorg sounds like an evil spirit you will want to ward off, but it’s a good thing. Zorg in Dutch means care. Kraam on its own actually translates to market booth, but when coupled with –zorg, it refers to care given to a woman who has just had a child.

A kraamzorg is a person who comes to your house to look after you for one to three weeks after you give birth, depending on your situation and what your insurance covers. She coaches you with breastfeeding and shows you how to change and generally care for your baby. She gives you time to rest and recover, and even does your shopping, cleans your house, and cooks your dinner.

My midwife gave me the number of a kraamzorg service. Like all things that are completely foreign to me and perfectly commonplace in the country I live in, I expected a catch, or at least a lot of questions. But the kraamzorg wanted only two pieces of information from me: Do I expect only one baby, and do I have a dog? Then she took down my address and said I would be receiving a kraampakket in the mail soon.

A few days on, a medium-sized box with an image of a koala bear and her baby arrived at my door. This box, my kraampakket, contains everything I need to deliver at home, from bandages to an umbilical cord clip to baby shampoo to a pack of diapers that I realized as I unfolded and unfolded one are actually for me.

With every encounter I’ve had with my midwife and now the kraamzorg service, I am left with a feeling that there is really nothing to fuss about. Rather than leave me feeling ignored or ill-informed, the simplicity of the system puts me at ease.

I am not by nature complacent, and I am definitely capable of digging in my heels and getting my way when I feel I’m absolutely right. But I’m also more than happy to surrender control when I trust that someone else has my interest at heart and better knowledge than I in a given situation. This is definitely true of my midwife, and I’m expecting it to be true of my kraamzorg.

If something feels off, I certainly will say so, and if I have concerns, I will absolutely voice them. But my midwife strikes me as so competent and capable that I haven’t felt any need to question her or fret about anything. The entire basis of the Dutch approach to pregnancy and labor is that my body is designed to do this. My midwife has seen this whole thing time and time again, and if she is satisfied that everything is going as it should, I’m quite happy with that.

Every three weeks I see my midwife, we listen to the baby’s heart, she checks my blood pressure, measures my uterus with her hands (I’ve yet to and most likely will not have any internal exams or even be weighed), and asks me how I’m feeling.

During my last visit, I mentioned that I’d been trying to count the baby’s movements, something I’d read to do in a book, but because I have an anterior placenta—it is on the front wall of my uterus—I can’t really feel kicks or movements as strongly or frequently as I would otherwise. Her answer: “Don’t count the movements. And don’t read books.”

Of course it helps that my life is full of things that simply do not allow me to obsess over my pregnancy, what with buying and selling a house, working full-time, negotiating a thankfully graceful divorce, embracing a relatively new relationship, and doing all this on two feet that have swelled to the size of bread loaves and with a belly that juts out so unnaturally that I frequently misjudge the amount of clearance I need to pass through a space. If my midwife tells me the baby is growing and developing well, then that’s one less thing to think about, and if my kraampakket holds all I need to have my baby at home, then cool.

I’m not sure this would work for all personalities. I definitely know people who need to arm themselves with as much knowledge as possible, thinking that is the best way to safeguard against anything going wrong. But I think more often than not, that method just introduces new things to needlessly worry about. And the fact is, there’s not much you can do to prevent many of the things that can go wrong. But I trust that my midwife will be able to detect anything that warrants concern, and will deal with it appropriately.

In the meantime, outside of taking care of myself and eating well and taking my vitamins and being sensible about things, there’s not much for me to do but let the baby grow.

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.”

“Yes.”

“Then you do not need a doctor.”

Click.

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.