The memories just crossed my mind again of those two times: when I gave birth to my first baby girl in the US, and 2 years later, to my second one in Netherlands. Even if both did not turn out the way I had planned, they do make for great memories❤... plus interesting and fun stories to share.
There are definitely BIG differences with how the system works in each country. This post however, is not for the purpose to criticize either or make or a statement as to which one is better. The purpose here is just to share the experience and hopefully peak your interest on what else is out there... Before starting though I ought to mention that I can't make a personal comparison with the full pregnancy in the US since when I came I was already almost 7 months pregnant (before that I was in France - I know, what's up with us getting the jiggle when having babies😉).
There are definitely BIG differences with how the system works in each country. This post however, is not for the purpose to criticize either or make or a statement as to which one is better. The purpose here is just to share the experience and hopefully peak your interest on what else is out there... Before starting though I ought to mention that I can't make a personal comparison with the full pregnancy in the US since when I came I was already almost 7 months pregnant (before that I was in France - I know, what's up with us getting the jiggle when having babies😉).
1. The "Caretaker"
In the US, as I seemed to understand once I came, you either pick an OB/GYN that will follow you until the big day of your delivery at the hospital; or you go with a midwife, which means if everything is right, you will most likely deliver at the birthing center. Right?
In France, I actually chose the combination of both (which is pretty popular): I was regularly and mostly followed by a midwife, but would go to the OB/GYN at the hospital few times for the most extensive appointments.
In Netherlands however, women are mostly followed by midwives. Whichever way you are expected to give birth, the midwife is the one who will follow you pretty much all the way. I was quite intrigued, as my 1st birth ended up in an emergency c-section, I thought that would call directly for a "doctor" care. I was actually told they would be the ones following me for the first 7 months, and then they will hand me over to the doctor at the hospital of my choice. Only the pregnancies with a certain "risk" for natural birth are getting this "special" treatment. That worked out great for me, so I was rather pleased with this "accommodation".
2. Caring for your pregnancy
Well... This was definitely different... See, even in France that I was followed by a midwife (VERY alternative midwife by the way - and I loooooooved her!), I was still given a series of blood tests at the beginning of my pregnancy and several times throughout. Those, in order to check for some histories, STDs, toxoplasmosis, my overall cholesterol, sugar, iron, white cells count etc, etc... This is just standard, for everybody. In the US, I did some too and I also had this gestational diabetic test (with this yummy drink to swallow - sarcasm here), this was also the case in France. And of course, I had regular gynecological exams to check how everything is down there - from the midwife and the doctors.
In Netherlands, I did not have ONE single gynecological exam. That was pretty scary for me. Not that I am looking for nor enjoying the process, but this was just something I was expecting, to kind of make sure that everything was "ok". I also believe I had only 2 or 3 blood tests (including the one to verify I am indeed pregnant, and the second being for the dawn syndrome probability check - all the standards). My appointments consisted of exchanging about how I was doing/feeling, check for questions and listening to the baby's heart. When I asked about all the other tests I was either answered by "do you have reason to believe you have an issue, like a STD? If yes, you need to go to you primary care physician to give you the test" or "well, everything was ok during your first pregnancy so there is no reason it should be different and you look in good health".🙄
I also did go to the nearby hospital for the regular echographies.
A funny story -
For my first baby, passed a certain month, I was told by my midwife in France - or just any doctor in France or US - NOT to use the bicycle (because of the risk of falling and the vibrations). In Netherlands I was using the bicycle to go to work everyday (like most people), which used to take me 20+ min, and later on 30 min... Around 8 months, I was really starting to feel some strong tightness and low abdominal pains everyday, which I cared to mentioned to my OB/GYN at my regular visit. Her answer "Well, can you still bike?"...😳Me (thinking, what the heck does this have to do with my issue?): "Yes, but that was my concern, maybe I should not". Her: "Ahhh, no! You can definitely continue taking your bicycle until the end"... "However if you are feeling pains that means you should rest a lot more so you need to decrease your time at work, 5 days/week is way too much for you right now"...😳... on that note, I was basically to keep biking to work but for the last month I was only to work 4 days/week (keeping my regular paycheck).
3. The Birthing Plan
On this side of the ocean, we mostly deliver at the hospital, or for some, at a birthing center with the midwife. If you go to a hospital, you can choose to have natural delivery but in general, women will get the epidural as soon as labor is on its way...
In France, the general situation is that you deliver at a hospital, but when everything is right, the midwifes are the ones delivering the baby... Only when tough "situations" occur, the doctor is called (unless we specifically require for the doctor to deliver).
In Netherlands, I was pretty impressed... The standard is actually to deliver at home. Since you are followed by a team of midwives, they will be the ones on call to come over your house to deliver the baby. They will also do the basic baby check-up at birth. From that, you can imagine that pain medication is not as used... You just toughen it up. In case of complications however, you would be sent in emergency to the hospital.
To be honest, I cannot say for sure if this is something women really prefer... A few women I have talked to had some pretty scary stories... while others had a wonderful experience. What you have to understand though is that most insurance plans will not let you deliberately choose to go deliver at a hospital just because "you want to", if there is no medical reasons. Actually, I remember receiving that huge "home birthing package" by mail from the insurance when I was maybe just about 6+ months pregnant. It consists of all the things you and the midwives will need you to have at home for delivery: big night pads, mesh underwears, compresses, gauzes, alcohol, gloves, mattress protections, etc... It's a standard, delivered to every mom. Even though I knew I would not deliver at home, I got a little bit scared seeing all of this supply here, but at the same time, how nice is it to send all those necessities!!!
In France, the general situation is that you deliver at a hospital, but when everything is right, the midwifes are the ones delivering the baby... Only when tough "situations" occur, the doctor is called (unless we specifically require for the doctor to deliver).
In Netherlands, I was pretty impressed... The standard is actually to deliver at home. Since you are followed by a team of midwives, they will be the ones on call to come over your house to deliver the baby. They will also do the basic baby check-up at birth. From that, you can imagine that pain medication is not as used... You just toughen it up. In case of complications however, you would be sent in emergency to the hospital.
To be honest, I cannot say for sure if this is something women really prefer... A few women I have talked to had some pretty scary stories... while others had a wonderful experience. What you have to understand though is that most insurance plans will not let you deliberately choose to go deliver at a hospital just because "you want to", if there is no medical reasons. Actually, I remember receiving that huge "home birthing package" by mail from the insurance when I was maybe just about 6+ months pregnant. It consists of all the things you and the midwives will need you to have at home for delivery: big night pads, mesh underwears, compresses, gauzes, alcohol, gloves, mattress protections, etc... It's a standard, delivered to every mom. Even though I knew I would not deliver at home, I got a little bit scared seeing all of this supply here, but at the same time, how nice is it to send all those necessities!!!
Now, I personally had to go to the hospital. So at 7+ months, I went for a tour my hospital was offering with explanations of what to expect, what were the options, and overall how things work. It was all in Dutch by the way so I will take this opportunity to praise google translate and its amazing functionality that allows to translate real time PowerPoint slides 😁. The point I want to make here was my big surprise to how they presented the birthing process in terms of pain management. They presented first all the natural ways, then a list of increasing strength pain medications, and then at the very end, "If you are REALLY in excruciating and unbearable pain", at very last resort, you can ask for the Epidural... At that time, I was still planning on being able to go through a V-back (a vaginal delivery after a c-section), so this scared me a little to be honest as I remember thinking I hope they will not let me scream until I pass out before giving me something... or needing to go to an emergency C... But nothing of this happened...
4.The Birthing Experience
Unlike I had hoped coming to such a "minimalist medicated" country, considering my own personal condition I was to have a planned C-section for this second baby. Pretty sad at first, but the doctors there never pressed me to choose this. I loved that they were so bold, direct and honest with the pros & cons and risks associated with each option, and how they will do everything to respect my choice. Considering the level of risk (mostly for my baby) in my case, it was clear to my mind which I had to choose.
But at least this enables me today to give you a pretty good comparison between the birth in the US versus NL. Moreover, the 2 hospitals we chose were pretty similar in terms of size (we chose the smaller size hospitals) and comfort (with the personal "suite" as they call those individual rooms & restrooms).
I could tell you a lot of course about this part because it's my favorite part of the story when I get to hold my baby 💕, but I will try to keep it straight to what should be of your interest in the subject😉.
In terms of the operation itself I will not go into details, I mean I am not a doctor... The only thing I will say I appreciated from the experience in the Netherlands are:
- the fact that they offered to put the baby on my chest right after they checked her in, even though the operation was still going on.
- the fact that my husband was sitting next to my head, next to the doctor, the full time (besides when they checked the baby he went with them).
- the fact that the team was ready to take pictures of us at birth, that my husband could take his Gopro... I mean don't get me wrong though, I NEVER want to look at those pictures he took of the birthing process, but the fact that he could do that was pretty nice. In the US, we were clearly told we could not take any videos of the birth (natural or not) - I am guessing it has to do with fear of law suits...?
- the fact that once the operation was over we all directly went back to our room (not in the recovery room as I was in for a while in the US). I am not sure why this was...
Time at the hospital
Like in the US, it was 3 days in Netherlands after a C-section. Actually even less, as on this third day they pretty much kicked us out early in the morning... They have moms waiting so they need to empty the rooms... If medically speaking you're good, then no reason to stay. I remember in the US however they did not mind us taking our time - we pay for it anyway 😜 (I will come to that money chapter in a little bit).
The medication part was maybe the most different part of it all! I remember being drugged so much in the US I had to tell the nurse to cut my drugs in half, to which she would answer that it's important I still manage low pain so that I can get up and practice walking with a straight bust as it was important for the healing- which I still did. However, as soon as I came back home I would barely take what they had given me... It was so strong for me... There was the combo acetaminophen/oxycodone, some ibuprofen (anti-inflammatory), and the stool softener.
On the other side, in the old viking country, I had only acetaminophen and ibuprofen equivalent for the first 36 hours, and from then, only acetaminophen - to decrease every day from day 4 and finish by day 7. I was in such a pain... I was remembering how "I am supposed to get up and start walking straight", but each time I would the pain was so powerful I would almost faint on my way back to my room/bed. Actually this time around, on day 2 (that I was just getting acetaminophen) I even asked for a bit "stronger" medicine, to which I was clearly answered no. The reason for this is that I have a brand new baby and the most important is for me to have a clear head and not be "dizzy". The pain meant I had to take it easy... Baby steps...
On the other side, in the old viking country, I had only acetaminophen and ibuprofen equivalent for the first 36 hours, and from then, only acetaminophen - to decrease every day from day 4 and finish by day 7. I was in such a pain... I was remembering how "I am supposed to get up and start walking straight", but each time I would the pain was so powerful I would almost faint on my way back to my room/bed. Actually this time around, on day 2 (that I was just getting acetaminophen) I even asked for a bit "stronger" medicine, to which I was clearly answered no. The reason for this is that I have a brand new baby and the most important is for me to have a clear head and not be "dizzy". The pain meant I had to take it easy... Baby steps...
Such different thinking🤔...The Dutch reasoning speaks to me a lot more... but each way makes a lot of sense because of what is in the next chapter...
5. Post Partum - Back at Home
US
The happy family leaves the hospital on its way back home and is now on its own with a brand new baby... Now if like us you do not have family living close and the mom just had a C-section, she's pretty "useless" - so to speak - as she can barely walk, can't bend and can't carry anything else than the baby and drugged up. Dad may or may not be lucky to still have a few days off and help around.
In our case, my husband was not given any days off, and bless his heart he still managed to be SO present, doing pretty much everything (house, baby, dog...), barely sleeping and working from home for a full week💙... Then we were very lucky to have his mom being able to fly in and come help us (a lot!) for a while as we were facing a pretty exhausting situation here...💛
This is also the case for so many other families, getting back home exhausted, in pain and on their own trying to figure things out ... so now looking back at it, the "reason" of such high medication for pain management makes a lot of sense ("technically"). The mom just needs to be able to handle taking care of basic needs + her brand new baby. She does not have the "luxury" to be able to "just rest", and "enjoy baby time"...
NL
If you have not experienced it, what I am about to describe here will sound like a dream... ✨
As soon as we know when we are supposed to leave the hospital, we call the "kraamzorg" company previously selected. There is not an actual english translation for this but it would be best described as a service for a maternity nurse, even though that description is too limited.
This person comes to our house as soon as we come back from the hospital, or as soon as the baby is delivered when it was a home delivery. She usually come 7-8 hours a day for 3/4 days and up to 7 days in case of C-section. She a specialized maternity certified nurse so her priority is to help with mother's cares (personal, healing, medical follow-up...), baby's care (check on weights, developments,...), help the parents with how to take care of the baby in his environment at home or when going outside (bathing, making a safe bed/environment,..), how to breastfeed, make appointment for the pediatrician and midwife to come visit during her stay to check on us,...
But that's not it - she helps taking care of the baby so that parents can rest, she makes the bed, laundry, clean the the place (bedroom and shower everyday to make sure of no infection), cooks, can do the grocery shopping, pick up elderly at school/daycare,... basically everything we would need help with!
Her help was very precious to us as we were not familiar with having a "winter" baby (first one was born in summer in Florida), but overall she made of that time being back at home a true enjoyable and absolutely marvelous memory. I had sent my first one with my parents in France, my husband had the week off, so we really got to relax and bond with our newly born... and freely watched movies... first time since our first one was borned we actually had such a relaxing time.
Bringing it back to the medication topic now, it makes sense that mothers can afford being on low medication as they are truly offered the opportunity to rest, take care of themselves, heal, to be able to be fully there for their baby.
Just for information, France does not provide for the same service as Netherlands does, however people are offered more days off as compared to US.
6. Maternity Leave
I am still unsure of the full rights mothers and fathers have (not) for the birth of a child. I understand that mothers can choose to take a 12 weeks unpaid leave, fathers do not have any privilege... I find this pretty tough.
In France, mothers get 16 weeks total of PAID leave (and more from 3rd child, or in case of multiples), they can then ask for unpaid leave (they may still perceive a small pension from the social security) or use their vacation time. Dad gets 11 consecutive days of PAID leave + 3 days for the birth.
In Netherlands, the maternity leave is similar as the one in France (16 paid weeks total) and 26 unpaid (depending on how long you've worked for the employer). The paternity leave however I found pretty low for such a country with only 2 PAID days but then companies have their own benefits - some pay 75% for 5 days... It is supposed to change to 5 days aid leave in 2017.
7. Money Talk - the cost💰
Huge difference on this topic as you may expect...
Our total out of pocket for the pregnancy (starting at 7 months) + birthing experience in the US ended up somewhere around $7,000.
In Netherlands, roughly 90 euros (~$100). Yes, you read that right, $100 for ALL the described above. $90 of this amount accounted for the hospital, which was actually the cost/participation for my husband staying with me 3 full days (change of his bed + his food) - that's pretty fair! The remaining, I am actually over-evaluating, as it accounts for our participation of ~$1/day for the maternity nurse...
The difference is pretty insane considering the comfort at the hospital was pretty similar.
And just in case you're wondering about the cost of our health insurance over there, it was about $250/month for the 4 of us (kids are actually "free"), but yes, there are considerably higher taxes there... but that would be a whole different conversation😉
I hope you enjoyed reading this (rather long) story and maybe discovered a thing or two of what exists out there... I would love to read any question or comment you have for me so do not hesitate to drop them below😊
As they would say over there - Tot Ziens! (Bye!)
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