Pregnancy in the Netherlands. All the basic information

Are you expecting a baby, planning to, or just curious to know how the whole process is in the Netherlands?
Then you are in the right place.

I just had a baby about two months ago, and decided to share all the relative information that might be useful. Thus from now on expect also posts in the series ‘Pregnancy’.
In this post you’ll find a summary of all steps in this journey, kept as official as possible. This means – for my personal experience and other matters (e.g. where to buy what),there will come other posts.

DISCLAIMER. My experience is rather limited (I had to do with one midwives practice only, in Eindhoven). It could be that there are some variations in how things are handled at different practices, but I believe the essential skeleton will be recognizable across the whole country.

Important to know before you read the rest!

One thing that is essential to know, is that pregnancy and delivery in the Netherlands are not seen as a medical condition/procedure.
This implies that when everything works out physiologically and according to plan, you are monitored exclusively outside the hospital by the midwives, and you are offered the opportunity to give birth at home.
Actually this is the standard delivery method included in the basic health insurances.
If you prefer to give birth in the hospital, you will have the choice to do so, also without medical indication, and you will be there by your own midwife. However, the costs for the hospital stay and treatments are on you in case hospitalization was not necessary. You can cover these costs by choosing a supplementary package for your health insurance. (But note that you can change your health insurance only at the end of each calendar year).

Midwives know well what is normal, and work in close collaboration with hospitals (both midwives and gynecologists there).

First things first

[Update 2023: at our midwives it since recently possible to also ask for a pregnancy test. I am not sure this is a shared trend, but it may be worth checking for a (maybe second) test!]

After a positive pregnancy test, you call a midwives practice.
You provide some personal information and schedule your first appointment at around 8 weeks.

The first appointment

At the first appointment, you get to know a first midwife who performs your first (internal) ultrasound. This way they can check if you are actually pregnant, and see if the small heart is beating. What you do not get (compared for example to Italy), is a blood check. At the same time, you have a first consult in which you talk about stopping smoking and drinking alcohol, about supplements (i.e. acid folic), and some other pregnancy-related information.
For example, I learnt about the possibility to take part to a clinical study, about the platform Moeders voor Moeders and about the possibility of taking extra (3D) ultrasounds at our own costs.
At the end of your first appointment, they illustrate you the next steps (more or less what you will read here below) and schedule the following appointment.

Schedule

At the practice where I was followed, I got a nice overview with a high-level schedule of appointments and things that need to be arranged during pregnancy.
Frequency of appointments
The general structure implies a check every (approximately) 4 weeks in the first 6 months, every 3 weeks in the following 2 months, then every 2 weeks (from week 30 to week 36), and a weekly consult from that moment until birth.
Ultrasounds
The standard number (without voluntary additions or necessary checks) of ultrasounds was 4 during the whole pregnancy: at the first appointment, at 12 weeks (first time you really see your baby! In my second pregnancy, this was already an ultrasound at the hospital to perform a thorough check), around 20 weeks (the SEO, the structural ultrasound), and finally around 34/36 weeks (to check the positioning of the baby).
Blood checks
Blood tests are performed at about 12 and 27 weeks.
The first discovers blood group, positive/negative rhesus factor, transmissible diseases of the mother (e.g. HIV, hepatitis) and if you decide to do so, check about genetic anomalies of both baby and mother (NIPT or combinatietest*). At 27 weeks the focus is on hemoglobin levels.

Which midwife

Since it is unpredictable when the baby will arrive, it is unknown which midwife will be present at birth. Therefore all midwives follow you along the process, alternating at .

After-birth care

The care at the midwives continues until the sixth week post-partum, meaning that the same obstetricians also take care of the after-birth care of mother and child, together with the kraamzorg.

Things to decide

1. *NIPT or combinatietest (12th week)
2. SEO (20th week)
3. Birth plan (30th week)
   

1. NIPT or combinatietest (12th week)

The first time you get a blood analysis, you can choose to have the NIPT or the combinatietest performed. Both test are meant to diagnose genetic anomalies. The well-known Down-, Edwards- and Ptausyndromes, but possibly also other genetic anomalies of baby and mother.
You will be asked whether you want
– to perform or not perform the test
– which test (combinatietest is free, older, probabilistic, with lower accuracy against NIPT that requires a contribution of 175 euro, is new and still under development, it has higher accuracy and can diagnose genetic anomalies both in the mother and in the baby).
– what to know (only the three well-known genetic anomalies above, or any genetic anomaly of the baby, or any genetic anomaly of baby and mother).

2. SEO (20th week)

All ultrasounds are an exciting moment, but the SEO is more. This is the structural ultrasound performed around the 20th week at the hospital and beside seeing your baby, he/she will be completely checked – organs and all. It is also the moment you discover the gender (unless you want to keep it secret; or you already know because you had some additional ultrasounds in the meanwhile).
As for all other tests, you can opt for not knowing anomalies, and certainly, the gender.

3. Birth plan (30th week)

Although you can always talk about your fears and preferences with the midwives, there is a specific moment during pregnancy in which you talk about your ideal birth with them. Around the 30th week, you will sit down a moment with a midwife to make the birth plan. This is not meant to be a strict rule, rather lose guidelines indicating your preferences, desires and expectations to the whole medical staff at that moment. It includes for example your choice of preference for giving birth (home or hospital), the possibility to get pain relief, the chance of giving birth in water and so on. Before discussion they provide information with pro and co’s, and introduce you to various positions for labor.
The midwife also enlightens you and your partner about the guidelines on when to call, indicating signs of possible problems or initiated labor.

Things to arrange

1. Health insurance it may be advantageous to get a supplemental package. Can be done in December only.
2. Kraamzorg and kraampakket After week 12, any time soon.
3. Erkenning if not married. Advisable before week 20.
4. Cursussen somewhere around week 30
5. Childcare as soon as possible.
6. Home adjustments after meeting with kraamzorg. Around week 36
7. Hospital bag week 36
8. Baby room
9. Baby stuff (stroller and so) before week 36. You need car seat to get home from hospital
10. Baby outfits always!

I realize squeezing all the necessary information about pregnancy and delivery in a single blog post is rather demanding. Therefore I will expand on some of the topics in subject-specific posts in the upcoming weeks.

Might you have questions or comments, do not hesitate to reach out to me. Also if you like reading this sort of information, share it! Sharing is caring and that’s a way to support me to keep writing!

Doei,
Marta