Happy New Year, friends! We are currently fighting colds and jet lag here in Amsterdam, which has made blog posting seem impossible. I have literally had a cold for 2.5 weeks straight now (thanks, pregnancy immunity!) and it’s showing no signs of letting up anytime soon. Prim also decided to take this opportunity to revel in the jet lag stemming from our return home from California. It took her a whopping 6 nights to get back on track — by far the longest transition period we’ve had since we started taking these trips. Aaaand I’m currently writing this post at 3:30am because my pregnancy insomnia is REAL these days.

So, all of this is basically a really long-winded way of saying — I’m tired. We’re 6 days into 2017 and the whole year feels tiring. Ugh January. You’re always the worst.

Anyway, I’ve been wanting to update you all on how navigating my pregnancy in the Netherlands has been going, since I’m rapidly approaching the end here. Having been through one pregnancy in the US already, I have to say that I’m still sort of continually surprised by how hands-off (and dare I say common sense) the approach to pregnancy in the Netherlands is.

Once you get through the first trimester in the US, the intensity of the testing tends to slow down a little. There aren’t quite as many milestones to get through before the end of pregnancy, but there are certainly a few things that you still have to take care of. That being said, here’s the rundown of what you generally deal with in a normal, low-risk pregnancy in the US after week 14:

• 20 week ultrasound to detect any fetal abnormalities
• 20 week blood test to detect any chromosomal abnormalities
• Gestational diabetes test (standard is the non-fasting 1-hour test with a fasting 3-hour test to follow if you fail the 1-hour)
• Flu shot
• TDap shot
• Strep B test
• Late-stage ultrasound to check baby’s size and positioning

Here’s what’s standard in the Dutch system after 14 weeks of pregnancy (again, for a normal low-risk pregnancy)

• 20 week ultrasound to detect any fetal abnormalities

Yep, that’s it. I ended up doing the gestational diabetes test here due to a family history, but even that is only one test — a single 2-hour fasting test, rather than the potentially 4-hours you might spend over two days in the US. (Please note that in the US I had to do the 1-hour test TWICE due to family history and the 3-hour test — and all three came out negative for GD.)

I did opt into getting Prim and I flu shots here since I knew we would be traveling back to the states over the holidays, but I had to pay out of pocket for the vaccine.

The TDaP is a standard vaccine for babies here (I believe they get their first round at 4 weeks) but not for pregnant mothers.

The strep B test was sort of fascinating, as I tested strep B positive in my pregnancy with Prim, which meant that I had to have a whole mess of IV antibiotics while I was in labor. I asked my midwife about the test here at my last appointment and she informed me that they only test if you have a risk factor for it (much like pretty much all of the other tests). She explained that strep B rarely results in a sick baby and so many people test positive for it, meaning that they have to be pumped full of antibiotics for something that will likely not cause harm. The Dutch believe that unless there’s reason to believe that it’s something that will negatively affect the baby, the best course of action is to leave it alone (thereby avoiding the baby being exposed to all sorts of antibiotics in the meantime).

Now, as I think I’ve said before, I can definitely see how the Dutch approach to pregnancy would not be for everyone. It’s much less hand-holding than the US model, and if you’re someone who has a lot of anxiety in pregnancy, the more medicalized model that the US follows might offer you some valuable peace of mind. I, personally, have really enjoyed the Dutch approach so far. Given that I’ve been through one normal pregnancy already, I generally know what to expect and where my risk factors lie. I appreciate the fact that the Dutch treat pregnancy like a very normal process which your body was built to handle. A lot of autonomy is given to the pregnant woman here (my midwife didn’t even bat an eyelash when I told her of my plan to fly to and from California at almost 30 and 33 weeks, respectively). They assume that you know your body and that you have a vested interest in the fetus, so you’re the least likely person to put yourself or the baby in unnecessary danger.

What a concept, huh? Trusting a woman to know and manager her own body. Fascinating. (Please note the heavy sarcasm UNITED STATES.)

And a final note, because I thought this was such an apt illustration of the difference between the two systems:

During my last midwife appointment before my trip back to the states, my midwife laid me out on the examination table and felt my belly to determine the baby’s position (no need for an ultrasound here!) For the first time this pregnancy, she pulled out a measuring tape and measured my fundal height, rather than just feeling it. I was a little over 29 weeks at the time, but was only measuring 27. Now, in the US, if you measure +/- 2 weeks or more in either direction (meaning that you’re carrying small or large), you’re required to go in for an additional ultrasound to check growth size. My midwife felt around my belly some more and said, “I’m just trying to see if the baby is big enough. She’s very low — she’s so low I can’t feel her head, so I have to just go off the size of her body.” She ended up pulling out a model of an average-sized 28 week fetus and said, “Oh yes, no you’re baby is much bigger than this,” and sending me on my way. No need for an ultrasound, no reason to worry.

For those of you who haven’t been pregnant before, here’s why this was so great — because the baby was already engaged in my pelvis during that appointment, I’d already effectively “dropped,” which can make fundal measurement inaccurate. (As an example, in my pregnancy with Prim I always measured exactly on track, then at my very last appointment at 38 weeks I was only measuring 36 — most likely because Prim was already engaged and super low in my pelvis at the time, something my OB told me was “completely normal” at the end of pregnancy). Baby #2 has since come up a bit (thank goodness for the sake of my ability to walk) and I am now measuring perfectly on track again. But what a nice experience to have a medical professional use common sense to trouble-shoot a very common problem and use her experience to not only reassure her patient, but have her avoid a whole lot of additional worry and headache.