One of the things I’ve noticed being pregnant in the Netherlands is how attentive my midwives have been to my birth preferences. The conversation about my “birth plan” literally started at my very first appointment. Home births are very common here, with somewhere around 30% of women delivering at home, as many insurance plans will only cover a hospital birth with medical necessity. When I signed up for insurance here I knew we wanted to have another baby, so I opted into a higher-priced plan which covered hospital birth without medical necessity (though I’m pretty sure that my history qualifies me for a hospital birth either way).

I’m not against home birth in principle, but I personally prefer to deliver at the hospital, so I informed my midwife that I would be planning on a hospital birth. She had consulted an OB-GYN about my medical history (as I had brought my medical records from my previous pregnancy and ER stay) and felt that my decision to deliver there was a good one.

Once I reached 20-something weeks I was given a form to fill out with my birth preferences. I filled it in and brought it to my next appointment where my midwife reviewed it thoroughly and we discussed my wishes.

This whole process was such a departure from my experience in the US, where any discussion of my “birth plan” was completely lead by me — not my doctor. I prepared a birth plan all on my own in the US and brought it to an appointment with my OB where she stuck it in my folder without even glancing at it. And since I ended up going to the hospital to be induced without any warning, I didn’t have my birth plan with me to give to the nurses so I just told them what I wanted verbally.

Luckily, I had some great nurses and doctors who were very supportive of my wish to labor naturally, and I was well taken care of during Prim’s birth. I have spoken to many friends who have not had such positive experiences trying to labor and birth without drugs or additional medical intervention in the US.

Here in the Netherlands, birthing without drugs is the norm. Only about of 10% of women receive an epidural here. This is partially because fewer women deliver in hospitals here than in other modernized countries, but also because anesthesiologists do not work the way they do in the states. Here, anesthesiologists often aren’t available after-hours, and if you request an epidural and the anesthesiologist is busy, it’s highly likely you won’t receive one. (I’ve also heard that if your nurse thinks you don’t need an epidural that you won’t get one.)

Since the Dutch treat pregnancy and birth like such a normal process that the body is designed to handle, this approach isn’t all that surprising. I have spoken to women who have received an epidural here — one of my midwives had almost exactly the same experience I had during her birth, where she labored as long as she could on pitocin after having to be induced and finally gave in and was given medication when she became too exhausted — so the epidural-assisted birth does indeed exist here, it’s just much rarer than in the US. C-section rates are also considerably lower here.

Here’s a comparison by the numbers between the US and the Netherlands:

• Births via C-Section:
  • US: 32.7%
  • Netherlands: 7.7%
• Epidural use during labor/delivery:
  • US: 60%
  • Netherlands: 10%

Coming up tomorrow: my birth plan and the Dutch postpartum approach. Stay tuned!