Holland: Learning from the Dutch

This blog was written by Jim Henderson, Ph.D., Jan’s husband, HUG Your Baby’s Vice-President, and developer of The HUG for Dads.

Travel lets us appreciate how cultures have developed in different ways to meet shared human needs. During the HUG Your Baby International Teaching Tour, Jan and I have enjoyed sampling each country’s amazing variety of food, music and visual art. We’ve also been fascinated to learn about the different customs cultures have evolved for welcoming babies to the world and for preparing moms and dads for parenting.

Though Jan and I generally try to avoid judging or ranking cultural practices, when it comes to the various national systems of health care we have encountered it is hard NOT to compare them to what America offers. By most measures (using both international standards and our own impressions), America comes off pretty poorly in comparison to the systems of health care that most other developed countries have evolved—especially with regard to care provided for babies and mothers.

In The Netherlands we were particularly impressed by how the Dutch health care system has evolved to offer excellent maternal-child care. We learned a great deal from chatting with our host in Holland, Elly Krijnen, a nurse, IBCLC, educator, mother of three, former owner of a maternity center in Amsterdam, and currently co-owner of “Baby & Borst” in Almere.

For centuries, midwives (vroedvrouwen, or “wise women”) have been at the center of Dutch health care. During the last century, as medical science advanced, Dutch midwives held their ground as a distinct, and powerful, group of practitioners. To this day midwifery is the standard of care in Holland (as it is in many European countries, as well as in Australia and New Zealand). Dutch women who do not have medical complications give birth in the hands of midwives.

A generation ago the majority of Dutch women gave birth at home. Today about one-third of babies are born at home in Holland. Women can choose either a home or a hospital birth. In either case, midwives do the delivery, unless there is an emergency, a medical complication, or some other special indication. But excellent midwifery care is just the beginning of the benefits that are guaranteed to Dutch citizens through the basic health insurance premiums of $140/month that everyone is required to pay.

Beginning in the 1950s the specialized profession of “Maternity Nurses” (kraamverzorgenden) evolved. To this day, new Dutch mothers receive, according to their needs, either three, five or eight hours per day of “maternity nurse” care during the first eight days after their baby is born. 

Kraamverzorgenden not only participate in labor and delivery. They educate their clients, one-to-one, about baby care—and also will cook, clean up, provide care for other children, or do whatever the family needs during their daily home visits.

New mothers receive sixteen weeks’ paid maternity leave, time that typically begins four or six weeks before delivery. Beyond this, parents may elect to take another six months of non-paid “family leave,” during which time their jobs are guaranteed. Dads get just two days of “paternity leave,” but they may also exercise their option to a portion of the family’s total leave time.

Mothers in Holland have the right to breastfeed at work. Either a work place must provide an approved lactation room, or the employed woman may take off up to 25% of her work time (paid, for nine months) to accommodate breastfeeding. Holland has done the research and concluded that the benefits to both society and business justify this arrangement. Furthermore, lactation consultations are paid for by most insurance companies in Holland.

Beginning with the third week of life, Dutch families receive well child care, and parenting guidance, from the Consultation Bureau (see photo), where they see a nurse and then a doctor (on alternating visits) once a month during the first year of life.

As America, at last, begins to move toward justice in public health, American citizens, insurance companies, and policy makers are wise to embrace or adapt policies and practices that have proven effective in other countries. Wouldn’t the USA be a better, healthier country if it treated its mothers and babies as they are treated in Holland? Jan and I—and HUG Your Baby—think so!