Giving birth abroad

Giving birth abroad
Giving birth is exciting. Giving birth abroad is even more exciting, with the combined hurdles of a foreign health service, no immediate family in the area, and also the problem of a communication barrier often arising. So what do you do when, as an expatriate or impatriate, you find yourself pregnant? Some women remain in their country of residence, while others choose to return to their motherland for the experience. The Heineken medical service, Heineken International Medical Services (HIMS), advises on this choice.

Giving birth in your own bedroom without an epidural and the next day only a midwife* next to your bed - the typical Dutch method of child birth - is a strange experience for many foreigners. Conversely, most Dutch women are bemused at the medical hubbub being conducted over them when they give birth abroad. HIMS attempt to offer solutions to these questions and different approaches.

Difficult decision
The HIMS is a team of people which provides expatriates, their partners and their children with medical advice. The medical says that they handle a fair number of cases every year when an expatriate partner falls pregnant, and then has to make the difficult decision whether they are to give birth locally or back in their motherland. 'When we are contacted, there is no Standard procedure that we can follow,' the HIMS says. 'We have to treat each case individually. Where does she live and what are her preferences? And from these questions and their answers we try to build up a realistic picture of the situation.' The HIMS know most of the expatriate and impatriate postings intimately, and have a good knowledge of the quality of the local health services.
There is no problem with giving birth in most countries, but on occasion we will urgently advise the pregnant woman to return to the Netherlands.'But whether the decision has been made to stay or to go, HIMS still maintains close contact with the pregnant woman. They discuss the examinations wich are conducted and the results by telephone or email. Many women want our opinion on the results of a certain test, or they cannot decide whether to have an amniocentesis performed, and would like us to make an expert decision.'

Less rigorous
Although contact is maintained with impatriates too, the HIMS says that they keep less rigorous tabs on them: 'Impatriates in the Netherlands quickly find themselves well-settled within the Dutch health system and as a result have less use of our services. But we can refer impatriates at an early stage to a general practitioner or an obstetrician.' According to the HIMS, the Dutch health service can take some getting used to for foreigners who have experienced very different procedures. 'Most people, for example, are not used to first consulting a general practitioner. In other countries you would immediately go to a specialist in a hospital.'

Grietje Miedema, founder of Cradle and herself a maternity nurse, agrees that there are vast differences between giving birth in the Netherlands and abroad. Cradle is an organisation which offers expatriates the opportunity to allow a Dutch midwife* to be present for the first eight days after a child is born. The obstetric system is typically Dutch,' says Miedema. 'In other countries, pregnant women are sent to a hospital where they consult with a battery of doctors. In principle, your only contact is with the obstetrician in the Netherlands. Only when complications a rise are women referred to other specialists, a gynaecologist, for example.' Obstetricians work independently from hospitals, making a home-birth possible. 'A lot of women prefer giving birth in their own home environment. It has a calming influence upon them.' The number of women who give birth at home in other countries is like looking for 'needle in a haystack', she says.

According to Miedema, there are also widely divergent ways of dealing with the pain. 'Dutch women overwhelmingly choose to have a natural birth, without an epidural. Abroad I've met people who find this a barbaric practice. There are also far fewer caesareans performed in the Netherlands.'

The final major difference between giving birth abroad and in the Netherlands is the use of a midwife*. Every woman who has just given birth in the Netherlands, has a right to a midwife*. 'In the first week, the midwife* will pay regular visits', Miedema says. 'She will advise and help the mother, and also ensure that the rest of the household is still running.' She knows that midwifery* is unknown in other countries. They generally send women home from the hospital after a few days, leaving them to their own fate.'It is essential that future mothers are well-informed about the quality of the health service in their area. The HIMS advises women to talk to other expatriates about their experiences. 'First-hand information swapped between expatriate mothers tends to be the most accurate when it comes to making such a decision. After-all, mother knows best.'

* In dit artikel is 'kraamverzorgende' vertaald als 'midwife'.