In collaboration with Duitslandnieuws.nl
Original (in Dutch): https://ulrikenagel.nl/en/blog/2016/07/duitsland-of-nederland-waar-bevalt-het.html
Recently, the discussion about pregnancy and childbirth has been in full swing again in the Netherlands. Are we in the Netherlands a role model for other countries, or is it done better in Germany, for example? Journalist Ulrike Nagel has now gained experience with pregnancies in both countries. In her opinion, we can learn from each other. She is of German origin but has lived and worked in the Netherlands for many years. She had two children there. She has been living in Berlin again for four years now and has since become the mother of a third child. She is well-positioned to compare the healthcare systems and the culture surrounding pregnancy in both countries. Which does she prefer?
You’ve already given birth twice in the Netherlands, even though you grew up in Germany. Did you experience anything back then that you found strange as a German?
When I found out I was pregnant in 2007, I went to see my family doctor in Utrecht and expected something to happen. She sat across from me with a small chart used to calculate the due date and congratulated me. And she said nothing would happen for the time being. “Find a midwife and check in with her again in a few weeks. No, we don’t check to see if you’re really pregnant—the pregnancy test is already 99% accurate.” That surprised me, but I just accepted it the way she said it. Since I was from Germany, I didn’t really know back then how things worked there, because I was one of the first in my circle of friends (both German and Dutch) to have a child, and I’d already been living in the Netherlands for almost ten years.
So I found a midwifery practice and went there regularly. The entire process—an ultrasound in the 9th or 10th week to determine the exact due date, an ultrasound in the 20th week, weighing, checking blood pressure, and, most importantly, listening to the heartbeat, and a 3D ultrasound in the 30th week—all seemed logical to me. The visits to the midwife were always quite short, which I found a shame, because in the Netherlands you’re out the door after 5 to 10 minutes. But her approach was always very positive and caring; she assumed that I was healthy and that everything would proceed naturally—and that’s exactly what happened. So I was never referred to a gynecologist with either of my children—there was no reason to. I learned that only if there were risks would a somewhat “more medical” process at the hospital be necessary.
Since everything went very well for me both times, I found the whole experience very positive.
Above all, the attitude toward childbirth: It was made very clear to me that I had the choice: to give birth as an outpatient (meaning to go home quickly after delivery at the hospital) or at home.
As a true Berlin native from the big city, I initially found the idea of giving birth at home in the Netherlands very strange. It seemed to me like something out of a village at the beginning of the last century, so my natural choice was the hospital. As a German, you just don’t think as quickly about something so “unknown”—the hospital seems like the safest option; if something happens, they can intervene quickly.
And then the birth went completely differently than I’d expected: much too fast. “We’re not going anywhere anymore,” the midwife said during the birth of my first child, and I agreed with her immediately—I wouldn’t even have been able to walk down the stairs. I still remember those following hours—contrary to my expectations, I found the whole atmosphere at home fantastic. A midwife joined us; everything was tidied up without me even noticing; my bed was made just like in a hotel room; everything was harmonious and just right.
That’s why, 3.5 years later, I made a conscious decision to give birth to my second child at home as well. I was just a little afraid of having to get into a car right before giving birth and then possibly experiencing pain on the way, thinking, “The main thing is that we make it, the main thing is that we make it.” It seemed more relaxed to me at home, and that was also the case the second time. The mindset of “It’s a natural process; your body can handle it” has always resonated with me—it brings a lot of peace of mind, and I was never afraid of giving birth in the Netherlands.
Now you’re expecting your third child, and you’ve been living in Germany again for a few years. What differences have you noticed so far compared to the Netherlands?
For one thing, here you don’t go to your family doctor first—you go straight to your own gynecologist. I was already used to that from back then, because if you want to take the pill as a teenager in Germany, you have to see a gynecologist—or a “women’s doctor,” as they’re usually called here. You have to get a Pap smear, have an exam, and only then does the medical assistant give you the prescription for the pill. And if you get pregnant, you naturally go to the same practice. So I was used to that again.
However, the exam was immediately quite different. And so was the doctors’ approach. Instead of congratulating me right away, she asked cautiously, “Was this a planned pregnancy?” I noticed how neutral that question was, and also that the doctor wasn’t exactly happy or enthusiastic about me and my news—it was as if she were deliberately holding back. This made me immediately sense the hierarchical distance between “doctor” and “patient.” At first, it struck me as less friendly and compassionate, but as I thought about it further, I found it quite logical. The practice is located in a city with nearly 4 million residents, and by no means every woman who walks in here will be happy about her pregnancy. So a cheerful “Congratulations” could come across as completely inappropriate to someone else. And they rely on that experience.
As far as the exams go, they do a lot more here than in the Netherlands. Right at the first appointment (when you’re usually in your 5th or 6th week of pregnancy), they use an internal ultrasound to check whether the pregnancy is actually confirmed, whether there’s one or more fetuses, and whether everything seems to be okay. You have to urinate into a cup (and you have to do this as standard at every appointment), because the urine is tested for pH level, proteins, and bacteria. You’re also weighed precisely, and blood is drawn not just once, but several times. The gynecologist handed me a sort of “shopping list”: a toxoplasmosis test for 15 euros, an additional ultrasound for 60 euros, and there are many other tests you can opt to have done. That seemed like a very good precaution to me, but I also realized that a practice like this simply makes money off every single test. Either you pay out of pocket, or your health insurance reimburses the costs and then pays the practice. That, along with the fact that the German healthcare system is extremely risk-averse, is one of the reasons why gynecologists in Germany perform so many tests. If something could happen, we’ll check to see if it might actually happen—even if it’s unlikely. But you never know. After all.
Starting at the 25th week, for example, you’re hooked up to a machine for a full quarter of an hour that measures whether you’re having contractions. In the Netherlands, that would be unthinkable if you were just going to the gynecologist. And starting around the 30th week, they use a CTG to monitor the baby’s heartbeat for half an hour. It all seemed very excessive to me, partly because they don’t really give you a good explanation of why all this is necessary. Until one day at the doctor’s office, I saw a sad-looking couple sitting in front of me. They were visibly worried, and a short time later, the woman was actually picked up by an ambulance on a stretcher. I tried to subtly find out what was going on: She was just a little over 20 weeks pregnant. At the clinic, they’d determined via ultrasound that the baby was much too small, and they’d also already detected contractions. Bad news—so off to the hospital right away. Ever since then, I’ve wondered whether something like this would have been noticed just as quickly in the Netherlands. The woman was bleeding, and in the Netherlands, in such a case, you’re usually sent home first. Not here—a good German friend of mine once spent an entire week in the hospital for this, even though there was nothing wrong.
There are two things to keep in mind here: On the one hand, all the commotion, all the tests, and all the things that could go wrong make you feel insecure. Childbirth feels less natural and takes on a medical character. You become less confident in your own body. On the other hand, doctors can act much more quickly if something is actually wrong.
This is a very topical discussion in the Netherlands right now, and I, too, know friends and acquaintances there who lost their child before birth. Often they don’t know why, and it can’t really be investigated properly either. And although I’ve always thought highly of the Dutch “natural” method, I’ve now become a bit more skeptical about whether the German “monitoring” is really that bad.
In any case, it’s very expensive, which sometimes gets out of hand here. But as a parent who may be at slightly higher risk, you probably benefit from it the most.
Since I’ve had two children at home, I’m not particularly keen on a hospital birth here either. While that’s absolutely the norm (though only about 3% of German women give birth at home, and there are only about 380 midwives nationwide who assist with home births), but first of all, you have the choice of which hospital you’d like to give birth in (which really seems to be a science in itself, judging by what I hear from other pregnant women who spend entire afternoons and days figuring out which hospital is the best), and you can also choose other options, such as a birthing center—a middle ground between home (cozy, comfortable, warm) and the hospital. There are several options, and everyone chooses what feels best for them.
I set out to find a midwife who assists with home births, but there are very few of them. The midwifery practices I called often told me: “We only handle birth preparation and postpartum care, but we don’t handle the delivery itself.” This is due to the extremely expensive insurance that midwives here are required to carry. They pay 4,000 euros or more per year to insure themselves against the risks of childbirth—which is simply unaffordable for many midwives. That’s why many are giving up their profession, and it’s dying out in Germany. Or you have to work as a midwife in a hospital—but that’s not what everyone wants, my own midwife tells me; she therefore prefers the “natural” approach and regularly tells me how excessive she finds the medical approach in Germany.
This natural method works fine for my body. And yet, and yet. When I show her an ultrasound image, she barely reacts to it, because she, too, thinks that far too many ultrasound exams are performed. She feels how the baby is positioned, she measures my belly and my uterus (with a measuring tape, actually), she listens to the heartbeat, and she takes an hour and a half for each consultation. That often feels a bit too long to me, because we frequently get caught up in discussions about how things work in the Netherlands (which she seems to prefer) and how there are far too many scheduled C-sections in Germany, or how people react hysterically if you’re even just one day past your due date. But the fact that they don’t check urine in the Netherlands—she just doesn’t get that at all, because it’s a very simple way to detect things like preeclampsia. By now, I don’t understand either why that isn’t done in the Netherlands. And listening to the baby’s heartbeat for half an hour—she does that in her small practice, too.
