Category Archives: Life Abroad

Life Abroad / weekend

Snow Day!

February 13, 2017

It snowed over the weekend in Amsterdam! It has snowed here before, but usually the flurries don’t last long and don’t really stick for more than an hour or two, so it was exciting to have a few legit inches throughout the day that stuck around for all of Saturday and Sunday.  Prim was bundled up and spent some time out on our terrace with KC while I was inside dealing with some fun contractions (yayyy for prodromal labor. Not.)  Prim’s outfit was complete with her plastic multi-colored elastic heart bracelet. Obviously.KC built Prim a little snowman, but she was really more interested in just hanging out and eating the snow.Thanks for the awesome snowy weekend, Amsterdam! (And kudos to baby #2 for staying put during the storm since KC is stressed out enough waiting for your arrival 😉 )

Life Abroad / Pregnancy

My Birth Plan

January 11, 2017

Obviously the grammar could be cleaned up a little…

In case you’re curious, here’s what I laid out in my birth plan*, based on the format provided by my midwife (with the specifics being basically identical to what I asked for when laboring with Prim):

  • My expectations regarding my pregnancy and delivery:
    • Give a short description of how you see the course of your pregnancy and delivery
      1. Calm, normal and quick (ha!)
      2. I would like the delivery to be calm, peaceful and supported. I would like to be able to dim the lights and play music in the delivery room.
  • Who will be present during delivery:
    1. Husband, midwife, any necessary medical personnel.
  • Contractions: relaxation and pain relief
    • If applicable, which positions would you prefer to soften your contractions whilst giving birth? (eg: walking, on the birthing stool, showering bathing, etc.)
    • How would you prefer to counter the pain associated with the contractions? (eg: breathing techniques, etc.)
      1. Would like to try all available positions to soften contractions (walking, birthing stool, shower, bath, etc.)
      2. I would like medication/epidural pain relief available, but hope/prefer not to use.
  • Where would you like to deliver:
    1. At the hospital (OLVG Oost).
  • Special treatments/interventions during deliver?
    • Do you have any other wishes or ideas about your delivery not mentioned above?
      1. I had a delayed, massive postpartum hemorrhage following the delivery of my last child due to a large blood clot.
      2. I have had back surgery on L5/S1 and have a bulging disk at L4/L5 — if given an epidural, it needs to be above L4/L5.
      3. Prefer delayed cord clamping, especially if baby is born before 37 weeks.
  • Postpartum period
    • Do you want to breastfeed or bottle-feed (with formula) your child?
    • Do you have any other wishes or ideas about your postpartum period?
      1. Skin to skin immediately following delivery, for as long as possible.
      2. Husband to cut umbilical cord.
      3. Breastfeeding exclusively as soon as possible after delivery.

My midwife reviewed my plan thoroughly and informed me that this is all “very standard” in the Netherlands — including delayed cord clamping (it’s the standard to delay clamping in all births here). Also, you get to eat during labor here (hallelujah!) As I’ve mentioned before, I wasn’t allowed to eat anything for over 24 hours while in labor with Prim and was STARVING, so I’m glad that I’ll at least have the option to re-fuel as needed here, without having to sneak it behind the nurses back (because, yeah, I would this time).

Now, obviously, a “birth plan” is kind of a misnomer in itself because birth plays out how it’s going to play out, no matter how hard you try to control it. The above is more a “birth wish list” of sorts; and just like I did when I was pregnant with Prim, I’m going in with the intention of letting my body do its thing naturally and will re-assess my needs as they come up in the moment.

An interesting note on the hospital and postpartum period here — the standard hospital stay is a mere 4 hours after delivery. That’s right, 4 hours after you deliver you’re sent home with your brand-new baby. Again, if this were my first child, I would probably be freaking out a little bit about this, but since this is my second, I’m ok with it (in principle). Obviously if you have any sort of complication or reason for extended monitoring you stay in the hospital longer, but part of the reason for the short postpartum stay is because you are provided a home health nurse for the first 8 days following birth.

Standard insurance covers a kraamzorg (basically a home postpartum nurse) for about a week after delivery, for anywhere from 3-8 hours a day. The nurse comes and checks your healing, assesses how the baby is doing, assists with breastfeeding, and will also watch older children, run errands, and do light housework.

Amazing, right?

Also, the first health appointments you have following birth (for you and baby) are conducted at home. The midwife comes to you for your postpartum check and the consultatiebureau (which handles pediatric care in the Netherlands) also comes to your house to check the baby. This is partially for your own comfort and also so the consultatiebureau can assess the baby’s living and sleeping situation (so smart!)

Further, when you actually go into labor in the Netherlands, the process is a bit different than the US. Much like the US, you call your midwife (or doctor) when you believe labor has started, but rather than managing it all on your own, here in the Netherlands your midwife will come to your house to monitor and support your labor. She tells you when it’s time to go to the hospital and accompanies you, and while at the hospital she can stay with you during labor if you would like the support. Once you’re ready to deliver, assuming you don’t have any complications, the midwife will deliver your child with assistance from a nurse. This means that if you have a normal, low-risk pregnancy, labor, and delivery, then you won’t actually see an OB or other doctor EVER during your birth or pregnancy. Nuts!

*I also went through a longer-form birth plan here, which is awesome any very comprehensive — but it is in Dutch and the google translate is only about 90% helpful. That said, if you’re looking for a birth plan template, this really covers all your bases!

Life Abroad / Pregnancy

Planning a Dutch Birth

January 10, 2017

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!

Life Abroad / weekend

This Weekend Was

August 24, 2016

KC took last Friday off work and it was raining, so we decided to take Prim to Tun Fun — a sort of Chuck E. Cheese-type place set up in an old abandoned subway station. I can see it being much more fun for a kid who is a little older — one who can run and climb things, but Prim had a great time parked in the ball pit meant for the little ones. 
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She was mainly interested in throwing the balls out of the ball pit, which she was surprisingly good at. There was a solid pile of balls outside the pit by the time we headed out (sorry Tun Fun staff…) img_9632

And of course I couldn’t resist the child-in-a-cage photo op.

After Tun Fun we hopped on our bikes and rode in the rain to get some burgers for dinner. I managed to ride into one of the inlaid subway tracks in the street and almost ate it on my bike, so that was fun. Luckily Prim was on KC’s bike and not mine. Definitely not one of my better moments. (Also, the things that come out of my mouth in moments like this are so not kid-friendly.)

We also hit up this local carnival/film festival thing called Parade. It was… interesting. I thought it would be a little more kid-friendly, like carnivals in the states, but this was more geared toward adults and only had one ride (a particularly terrifying set of swings that went in a circle and had a guy who would stand and swing you around viciously as you would pass by — no thanks). img_9630 Prim had a good time wandering all around the grassy areas while we were there, at least. (Prim’s Canadian tuxedo/denim-on-denim look was my fault because I couldn’t find her other sun hat before we left the house.)

Afterward we biked to a local restaurant I had spotted the week before and got a milkshake. (Because milkshakes are my favorite thing these days.)  img_9635The rest of the weekend was spent running errands and doing other usual weekend things. Prim spent some time breaking in her new floaties and getting used to the headphones we bought her for flights. It was quite the look. img_9628 img_9627

Here’s hoping that she loves those headphones enough to sit still for at least part of the flights back to California in a couple weeks… img_9626

How was your weekend?

Life Abroad / Pregnancy

The Dutch Maternity System

August 19, 2016

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Given that I’ve already experienced one pregnancy in the US, I thought I’d write a post about the Dutch maternity system. It’s pretty different from the US — much more hands-off. A friend of mine recently referred to it as “free-range pregnancy,” which I think is a pretty apt description.

When I was pregnant with Prim, here’s how the first trimester was:

  • blood test at 5 weeks to confirm pregnancy and measure HCG levels
  • blood test 2 days later to confirm HCG levels were at least doubling
  • doctor appointment and ultrasound at 6 weeks to confirm pregnancy with heartbeat
  • blood test to screen for antibodies, Rh, iron levels, etc.
  • doctor appointment at 10 weeks
  • ultrasound at 10 weeks to confirm due date
  • early glucose test due to family history of gestational diabetes
  • blood test for NT scan
  • NT scan ultrasound at 12 weeks
  • doctor appointment at 14 weeks

Here’s the first trimester in Amsterdam (omitting all the hospital crap I had to do due to the Hyperemesis Gravidarum):

  • doctor appt at 6 weeks to establish relationship with midwife
  • 6 week ultrasound to confirm pregnancy with heartbeat 
  • 10 week ultrasound to confirm due date
  • blood test for NT scan/blood test to screen for antibodies, Rh, iron levels, etc.
    • these tests are done together so you only have to go in for one blood draw
  • NT scan ultrasound at 12 weeks
  • midwife appointment at 13 weeks

The three things in italics above are things that are not customary in the Dutch system. We opted into these and paid out of pocket for them. If you went “straight Dutch” you would have two midwife appointments, the dating ultrasound and one blood test during the first trimester — that’s it!

Also, when I would go in for a routine doctor’s appointment in the US they would weigh me, have me pee in a cup, take my blood pressure, measure the height of my uterus, and listen to the baby’s heartbeat on the doppler. Here a standard midwife appointment is getting my blood pressure taken, having the midwife feel how my uterus is growing, and listening to the baby’s heartbeat on the doppler. That’s right — THEY DON’T WEIGH YOU. I’m kind of into it.

It’s also not customary to do the glucose/gestational diabetes test here. They apparently only test you if you have some sort of risk factor. And aside from the GD test (if you’re required to take it), there is no other blood work required after the single test done in the first trimester. Bananas!

I’ll fill you in on the delivery planning here on a later date, because that’s a whole other animal. But yeah, if you’re into hands-off pregnancy, maybe plan your next one to be here in the Netherlands!