Homebirth in Holland

By Maura Kikstra, as told to Sandra Gaffigan
Issue 144 – September/October 2007

Pregnant belly

“You know, they’re medieval here,” a Swedish friend told me. We were both from other countries, had Dutch husbands, and were pregnant in Holland. My friend ended up scheduling a cesarean section in a hospital, something that is increasingly available here. I chose the traditional Dutch model of homebirth under the care of midwives.

A year before, I and my husband, Dirk, had moved to Utrecht, an ancient university town near Amsterdam. Our daughter, Chloe, who was three when we moved, had been born in a New York City birthing center. But the system in the Netherlands, I found, goes a step further. Under the care of Dutch midwives, I birthed my son in my own bed.

Before Chloe’s birth, I read Ina May Gaskin’s Spiritual Midwifery and was hooked. I’ve always been interested in natural living, alternative medicine, and yoga, and am not wedded to the American system of medical care. I don’t even mind that some people call me “hippy-dippy.” But that first time around, I was so busy learning that I didn’t make time to enjoy the process of pregnancy and birth.

This time I did. I found the Dutch singularly supportive of new families. They allot a week of state-funded home care for mother and child. The Dutch call the first week following birth kraamzorg, and the woman who cares for the mother during that week the kraamvrouw. My kraamzorg turned out to be the most perfect week of my life. Much of my enjoyment was made possible by the way the midwives of Utrecht delivered their care.

At first I was nervous—the year before, in the US, I had miscarried. But over the months of my pregnancy, the vrutvrouwen (midwives) of Holland taught me to trust myself, and convinced me that it was I who needed to take responsibility for the birth of my son. My first inkling that I was not in America.

When I was about two weeks pregnant, I made an appointment with a Dutch general practitioner to confirm that I was pregnant. He took my word for it, recorded my name and address, and recommended a midwifery practice in my postal code. I never needed to visit him again.

I selected the Vroedvrouwenpraktijk Breedstraat practice, a short bike ride from our home in St. Martin’s Hof, a square of 18th-century townhouses surrounding a gated courtyard in the Binnestad district. During the interview, the Breedstraat midwives, too, took me at my word when I said I was pregnant. I was never given an internal examination. All they did was take careful notes—there was no examination at all. My American eyes wanted the reassurance of technology, but they didn’t even weigh me. Without tests, how was I to know that everything was all right?

In New York, I’d had regular internal exams. But the Breedstraat vrutvrouwen seemed to be doing nothing. They were so unmedical—no white coats, no important-looking machines. When I asked about a scale, they had to search the office for one. They would weigh me if I insisted, they said, but in their opinion it wasn’t necessary. The same was true for measuring my belly, which they didn’t do. “It doesn’t change the outcome,” they said. “We can see that your belly is growing.”

In New York, I’d always had to pee on a stick when I came in for an examination. “Why no urine test?” I asked Hedwig Pesgens, the midwife who would eventually help me deliver.

“A rise in your blood pressure will alert us to check your urine for protein. Your blood pressure is normal. We don’t do tests that are not necessary.”

Then it hit me: Oh. Pregnancy is a natural condition.

During a later visit, a midwife said to me, “We don’t open doors that don’t need to be opened.” Those words helped me to understand the Dutch attitude toward kraam (childbirth): If my pregnancy showed any abnormal signs, they would refer me to an obstetrician for pathological care. As long as everything was going along normally, they would help me, but this was my job: it was I who would be giving birth. I felt liberated. And scared.

In Holland, office visits are less frequent than in the US. I was shocked that the midwives didn’t want to see me again until I was eight or nine weeks pregnant. After that, I would see them every five weeks until I was 20 weeks along. The visits were then scheduled gradually closer together until week 37, after which I was to come in once a week. The standard procedure during these ten-minute visits was a blood-pressure check, a Doppler check of the baby’s heartbeat, and questions about how I was feeling.

My recent miscarriage drove me to ask for a sonogram (called an echo in Holland) early in my pregnancy, and my desperate need to know that this new baby was alive convinced the midwives to write a letter of request. Letter in hand, I arrived at the hospital for my test, expecting to be reassured by hearing my baby’s heartbeat. When I heard nothing, I panicked. The technician, a kindly older woman, pointed to the baby’s heartbeat on the monitor and cautioned that the noise of the echo itself was not good for the baby. Her thoughtful explanation set my mind at ease.

During a visit to Breedstraat in my seventh month, I remarked that I was experiencing frequent Braxton Hicks, the pre-labor “practice” contractions. Immediately, the midwives gave me an order for a urine test, and I better understood the importance of communication. Braxton Hicks contractions can be caused by a urinary-tract infection, and they needed to rule that out. My Braxton Hicks were perfectly normal; by paying attention, I found that taking the two flights of stairs to our apartment more slowly helped them subside.

Like the rest of the Netherlands, Utrecht is a bicycling city, and the midwives encouraged me to bike as long as I could. With Chloe in the ride-on seat, I rode the cobblestone streets. I would drop her off at De Twijn School at Pieterskerk Hof, then cross the Oude Gracht (a canal) to shop for groceries at Hoog Catharijne. This was our weekday routine until the day before Luke’s birth, and it turned out to be the best way to keep me fit and to naturally open my cervix.

Several weeks before the expected date of our son’s kraamtijd (time of birth), a Breedstraat kraam packet of all the necessary birthing supplies arrived at our door: bed pads, maxi pads, first-aid kit, alcohol, cotton—even a rag monkey for the baby. We had to pick up the blocks that were to go under the bed. The blocks address an occupational issue: The Dutch look out for the midwives’ backs, so the bed must be in a position higher than normal. This ended up being a little added adventure; from the time we placed the bricks under the bed until the birth, we felt as if we were taking a nightly voyage high on the North Sea.

The birth
By April 15, the bed had been up on blocks for five days. I took a 90-minute bike ride to Ikea. When I returned, I had increased vaginal mucus, but it was clear. We ate dinner and put Chloe to bed. As we watched TV, I remarked to Dirk, “It’ll probably be another two weeks.”

Around one o’clock the next morning, Chloe came into our bed. At about 4:30 a.m. I felt a punch in my vagina that woke me up. I went to the bathroom and found that my panties were wet and tinged slightly pink. I remembered what a friend had told me: “If it smells neutral or sweet, it’s fine.” It had no smell. I told Dirk, who said, half asleep, “Two days, go back to sleep.” I ran down two flights of stairs to the living room and fluffed the pillows on the couch. I have no idea why. Then I decided it would be wise to sleep as much as possible. I got back into bed, Chloe spooned behind me.

Around 5:30 a.m. I started having contractions and began to make low moaning sounds, remembering what Ina May Gaskin had said about keeping the jaw relaxed and the mouth open. I got up twice to use the bathroom and felt lots of pressure on my rectum. Chloe awoke. “Mommy, why are you making those noises?” I didn’t answer. Dirk asked me to get up, then remade the bed with the plastic sheets from the kraam packet. I lay back down on my side, feeling the heavy contractions coming constantly, with almost no breaks between them.

At 6 a.m., every bell tower in Utrecht began to ring in Easter Sunday. Their pealing made me moan even louder, deep and low. Chloe asked to leave—she preferred a neighbor’s quiet home to her moaning mother. Dirk and I wondered about calling a midwife on Easter morning, but decided we had no choice. Hedwig Pesgens answered and, from my noises in the background, immediately knew that the baby was on his way.

Hedwig picked up Herma Ebbers, a midwife-in-training, and they arrived at 7:16 a.m. Dirk ran down the two flights of stairs to answer the door. I was alone in the third-floor bedroom when I felt my son’s head come out of me—the most intense feeling ever, and beautiful. Mothers speak the truth when they say that, during childbirth, life passes through you. I felt like a hollow vessel, my son barreling through me on his way into the world. Because it all happened so quickly, my mind couldn’t catch up with my body. I thought, Yes, that’s Luke coming out. But if it’s not him, I am splitting in two. You could say that Luke birthed himself, and that I just opened up for him. We were such a team.

Hedwig and Herma scrambled up the narrow staircase to the third floor, to be met by Luke’s head. Both midwives were the essence of calm. Herma put on her gloves and said, “Don’t push. Turn on your back and grab hold of your knees.” I focused and did as I was told. Then she said, “When you feel the urge to push, do so.” My urge was to yell, “Come to Mommy, Luke!” With the next push, my ten-pound, six-ounce boy was born in all his perfection. It was 7:21 a.m.

Hedwig immediately placed Luke on my chest. We lay there skin to skin, my warmth mingling with his. Oxytocin flooded my brain and I fell in love. I couldn’t imagine my boy being taken away to be kept warm under a heat lamp.

The placenta was still inside me; I began to nurse Luke, which helped stimulate its birth. The after-contractions were intense. Hedwig said that this is normal when a birth happens so quickly. She joked that it was actually Luke’s twin, and for a second I believed her. She gave me a glass of water with a straw. “With each contraction, take a sip and the pain will diminish.” To this day, I don’t know if she gave me magic water or a magic straw. We couldn’t just throw the placenta away—it had been Luke’s first home. We kept it to bury later.

Hedwig and Herma cleaned me up with care. I felt complete love for Luke and Dirk and Hedwig and Herma. I wanted Chloe to join us, and Dirk went to get her. The four of us then lay together in our bed—a complete family. It was that simple.

Hedwig and Herma’s quiet observation of everything helped me to trust myself. Even Hedwig’s little trick with the water worked wonderfully. She read my body perfectly. I thanked Hedwig, and she thanked me for the pleasure of Luke’s birth. She and Herma taught me that silence and observation are the keys to successful birthing. If only I could carry those qualities into the rest of motherhood.

I’ll never forget the pealing of the bells from every church tower on that Easter morning. I was sure they were loud enough to drown out my moans as I pushed Luke into the world, but our neighbors in St. Martin’s Hof later told me that the bells hadn’t quite done the job.

Yes, they are medieval here. Like the bell towers of Utrecht, the midwife tradition in Holland is ancient and unbroken. On that Easter morning I joined the multitude of mothers who have given birth down through the centuries, listening to the same bells that welcomed Luke. They, like me, had caring and competent midwives.

Maura Kikstra is a full-time mom to Chloe and Luke. Sandra Gaffigan birthed Maura in a Washington, DC, hospital in 1971, and wishes that experience had been more like Luke’s birth. Sandra, a freelance writer, lives with her husband, James, in Columbia, Maryland. She keeps in touch with her faraway daughters—Maura of Utrecht, Holland, and Alison of Santa Rosa, California—by writing about her grandchildren, Bronte, Nolan, Phoebe, Chloe, and Luke.