A home help for eight days after giving birth? Why Dutch maternity care is the envy of the world
To new parents processing the shock of delivery and swimming in hormones, newborns can feel like a tiny, terrifying mystery; unexploded ordinance in a crib. “We were totally unprepared,” says Odilia. Neither she or her husband had ever changed a nappy and had no idea the baby needed feeding every three hours. “If you’re a new mum or dad, you have no idea,” recalls Anouk, a new mother. “I’m a doctor,” says Zarah, another new mother, incredulously. “So, you would expect that I’d know something, and I knew some things, but you really don’t have any clue.” For Giulia, an expat living far from the support of family and friends, a traumatic birth left her physically and mentally reeling. “I was running on adrenaline for days and days,” she recalls. The delicate process of caring for her premature son could easily have become overwhelming.
The difference for these new parents, compared to the rest of us, is that they gave birth in the Netherlands. That meant help was instantly at hand in the form of the kraamzorg, or maternity carer. Everyone who gives birth in the Netherlands, regardless of their circumstances, has the legal right – covered by social insurance – to support from a maternity carer for the following week.
These trained professionals come into your home daily, usually for eight days, providing advice, reassurance and practical help. It’s a different role to midwives, who continue to monitor women and babies after the birth in the Netherlands; the maternity carer updates the midwife on the mother and baby’s health and progress as well as supporting the parents as they come to terms with their new child.
If you’ve had a baby pretty much anywhere else in the world, this sounds little short of miraculous: exactly what many of us wished we could have had. I had my first baby at 27 and was discharged the next day to a top-floor flat far from family without the slightest clue what to do. My baby was given basic health checks but no one examined me, ever – not even at my six-week check (the GP just asked if I was OK and if I had considered contraception – I lied yes to both).
A maternity carer in the Netherlands, explains Betty de Vries of Kenniscentrum Kraamzorg, the organisation that registers maternity carers, “takes care of the woman the first week, advises her on breastfeeding and bottle feeding, hygiene, gives advice … everything to do with safe motherhood and a safe baby. She is there for the whole day most of the time so she can see how they are doing.” Her colleague, director Esther van der Zwan, adds: “It’s a lot of responsibility.” To prepare, maternity carers train for three years – a combination of academic and on-thejob placements – and have regular refresher training in everything from CPR to breastfeeding support.
For most new parents, the maternity carer is an incredible comfort and relief (“Kind of a luxury,” says Zarah), but it can be far more than that. An experienced pair of eyes and ears around the house can be crucial in preventive care, spotting potential health or wellbeing issues with mother, baby or family setup or warning signs of abuse or domestic violence.
Josette Veerman can tell, she says, the minute she walks into a home how the week will go. “You know it’s going to be a nice or a hard week, or: ‘Oh my goodness, what’s happening here?’” She has been a kraamzorg for 15 years. Before that she worked in a bank. “I came home and told my husband: ‘You’ll never guess what I’ve done today, I quit my job,’” she tells me, laughing on a video call. Now she has been present for the delivery of about 600 babies (“All a miracle”) and spends her life slotting into families at one of the most intense times of their life.
“Maybe they could have done without me,” she says of some new parents, but where families aren’t coping, it’s a different story. “You can’t make right in a few days what’s already gone wrong for years, but you can open up the discussion.” That can mean tough conversations with families around sensitive topics – good communication is key.
Her presence can also mean families “feel seen” and get the help they need – another part of her job is liaising with other parts of the maternity care system to ensure families get that support. “That’s what makes it so special and important.” She worked right through the pandemic, supporting new parents when no family members could visit them, and even now, if someone in the household has Covid she still works, in full PPE (though shifts are limited to three hours).
How did the Netherlands get this so right? Women there have historically given birth at home – the rate of home births is still much higher than in other European countries (almost 14% according to the most recent figures), though it has declined in recent decades.
The maternity-carer system grew out of the informal networks of postnatal carers that existed to support home birth. From the turn of the 20th century, concerted attempts were made to try to educate these informal carers in the new science of hygiene. Since the 1920s, an official registration system required maternity carers to train in order to receive a badge allowing them to work. By the late 1940s, the system was further professionalised so only certified maternity carers could care for mothers and babies at home. It was around the same time that a universal period of maternity care was covered by the Dutch social security system.
These days, the number of hours a family is entitled to has fallen – originally the maternity period lasted 10 to 12 days; now the legal entitlement is between 24 and 80 hours, though the majority of families receive a standard 49 hours. Parents pay a contribution – currently €4.80 an hour – towards the cost of the maternity carer’s time.
The actual experience will vary depending on the individuals and organisations involved (you can get a maternity carer through agencies or hire one independently, although what’s available may depend on your supplementary insurance cover and women also swap tips when they find one they really like). Some maternity carers clean the house and do the laundry (“The house was never so clean; the washing machine was going every hour,” recalls Zarah). One woman told me her kraamzorg even stayed over one night to support her when her partner was very sick. But whatever the specifics, the level of appreciation for the system and gratitude for the women who make it work is huge.
For Giulia, Zarah and Odilia, being able to go back to bed and rest for a few hours when the maternity carer arrived in the morning was particularly precious. “She took care of our son when I was resting, which was essential for me,” says Giulia. For Anouk, whose elder daughter was a toddler when she gave birth, “she was really helpful playing with her so me and my husband could have some quality time with the baby”. She had a home birth, and the maternity carer supported and advised her when her baby’s temperature dropped overnight, recommending she take her into hospital.
Giulia’smaternity carer arrived the night she was discharged from hospital, traumatised and “in really bad shape” after a very difficult birth. “She got it immediately, and really understood how to handle the situation,” she says. “Ours came in the morning and we were so happy,” says Zarah who was discharged from hospital late on the day she gave birth. “She was really helpful, especially with breastfeeding. She was very calm and made me more relaxed.” There were little things that made a difference, too: expert tips on swaddling techniques and skin-to-skin contact, helping out with the first bath and explaining the warning signs of mastitis.
For an outsider it seems potentially quite stressful to have a stranger in your home – would you not worry about them finding your mess, or judging your parenting style? “She’s suddenly in your house – it’s pretty crazy,” says Zarah. For Odilia, the relief far outweighed any potential misgivings or awkwardness. “I was really happy somebody was going to come.” Anouk’s experience was very positive but she has a friend who found it “a bit too much”, she says. “You have quite intimate contact and I don’t think everybody is really open to that.”
Being accepting and open-minded is a crucial part of her job, Veerman says. “You’re a kind of chameleon. You work with every kind of person: highly educated, people who can’t read or write, other languages, refugees, very different cultures.” One of the important skills, she says, is “being able to adapt and understand that people have such different perspectives. You have to find the way in between, because it’s not wrong what they’re doing, it’s different ...” Some families stay with her, inevitably, she says. Sometimes there are tears. But usually, she and the parents are ready to move on when the week draws to a close. “They’re happy you’ve come, but I always say that it’s healthy at the end of the week that they’re happy I will leave. It’s a good sign – they have that confidence.”
That chimes with what the new parents I speak to say. What they most appreciated was the reassurance the maternity carer offers: expert encouragement that they are doing a good job, building their confidence, assuring them that everything will be OK. Who wouldn’t want that? “It’s really nice if someone who’s more experienced in working with babies tells you you’re doing great now. You know that when she leaves, you feel like, OK, I’ve got this, we can do this,” says Anouk. Not everyone is quite as philosophical when the week is over. “I cried, I really cried,” says Odilia. But, she says, the kraamzorgtold her: “I would not leave if I didn’t think you could handle it yourself.” Anouk’s maternity carer said exactly the same. “I was panicky,” says Giulia. “But then you’re fine.”The kraamzorg system is the envy of much of the world; in the UK, David Cameron floated the idea of introducing an equivalent in 2008; the idea seems to have been quietly shelved by the time he became Prime Minister in 2010.
It’s not a perfect system, though. Some vulnerable families struggle to make the personal financial contribution required and end their maternity care period earlier as a result, while staffing shortages mean it’s currently under acute pressure. There are about 9,000 maternity carers currently working in the Netherlands (Kenniscentrum Kraamzorg has 9,500 on its books, but it’s likely not all are active at any given time); the government says that 11,000 more are needed. But pay levels are low (a maximum of €19.83 an hour, according to the professional body for the maternity care sector, Bo Geboortezorg), and as van der Zwan says: “It’s a tough job; it’s a lot of responsibility.” “It doesn’t earn you much, so you have to have a special feeling for taking care of babies and mothers,” says de Vries.
You also need to have “a big heart”