Dr. Rebecca Dekker – 00:00:00:
Hi everyone, on today’s podcast, we’re going to talk with Madi van Tonder about pregnancy, birth, and birth work in the Netherlands. Welcome to the Evidence Based Birth® podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details. Hi everyone, and welcome to today’s episode of the Evidence Based Birth® podcast. My name is Rebecca Dekker, and I’ll be your host for today’s episode. Today, I’m so excited to welcome Madi van Tonder to the Evidence Based Birth® podcast. Madi is a birth photographer, doula, and educator who founded her company, Meraki Madi, in the Netherlands. Meraki is a Greek word meaning soul, creativity, and love, which reflects the essence of Madi’s work. Madi has a degree in biology and education, is a certified doula, and recently completed her aromatherapy diploma. Originally from South Africa, Madi has lived as an expat in multiple countries over the last decade. Her mission is to provide safety and support, particularly to expats as they navigate the vulnerabilities of new cultures, new languages, and new healthcare systems. As a lifelong learner, Madi believes in empowering people through knowledge and creativity. Madi, welcome by the Evidence Based Birth® podcast.
Madi van Tonder – 00:01:40:
Thank you.
Dr. Rebecca Dekker – 00:01:42:
Hoeishetmetje.
Madi van Tonder – 00:01:43:
Erggoed. Well done.
Dr. Rebecca Dekker – 00:01:48:
Well, KunnenweEngelsspreken?
Madi van Tonder – 00:01:51:
Oh, yeah.
Dr. Rebecca Dekker – 00:01:51:
Okay. We’ll switch to English now. So I was just asking Madi how she was doing and she said, very good. So I’m so excited to continue our conversation. Madi and I began talking this summer when I visited in the Netherlands and got to meet with her and another doula as well. So Madi, can you share with our listeners a little bit about what brought you to doula work and particularly in the Netherlands?
Madi van Tonder – 00:02:18:
Of course. Thank you for the introduction. It’s really nice to talk to you again. I’ve always had a fascination with just human biology. So which is also why I did my degree in biology. And I ended up doing teaching. I was a teacher for 12 years because I liked working with people and I never knew what a doula was. And then when I moved to the Netherlands, a friend of mine had just completed her doula studies. And when she told me exactly what a doula does, I immediately just knew this is what’s been missing in my life. I get to tell people about how their amazing bodies work. And I also get to help people and work with people one-on-one, which is where my passion lies. So yeah, that’s kind of, it kind of happened by chance. Yeah, that’s where it started. And I was already in the Netherlands when I met her.
Dr. Rebecca Dekker – 00:03:03:
Okay. So you did your doula training in the Netherlands?
Madi van Tonder – 00:03:06:
I did it through an American company, actually online during COVID. And then I did an additional training in the Netherlands to understand the Dutch healthcare system.
Dr. Rebecca Dekker – 00:03:16:
Okay. So let’s talk about the Dutch healthcare system. You know, what is the typical prenatal or antenatal experience in the Netherlands?
Madi van Tonder – 00:03:25:
So if you don’t have any complications or any medical background, you only see a midwife. You never see a gynecologist. You don’t go to hospital. That would be the way that it goes. And it’s, you go to a midwife center, you have all your appointments there, and they will also be at your birth, whether that would be at home, or you can be led by your midwife team at a birth center. So that would be in the case that everything’s low risk, no complications. As soon as there are some medical reasons that for whatever reason, you need to see then a doctor or a gynecologist. You get transferred to the medical team in the hospital.
Dr. Rebecca Dekker – 00:04:06:
Okay. Correct me if I’m wrong, but does the Netherlands have a universal healthcare system then?
Madi van Tonder – 00:04:11:
What do you mean by universal?
Dr. Rebecca Dekker – 00:04:14:
So it’s so different in the United States. You have to have insurance. If you don’t have insurance, the cost of a hospitalization could bankrupt you. So you would lose all your money. So, and not everybody, you know, insurance is not a right or a given. It’s something either you have to get through your employer or you can, if you qualify financially, you could get public health insurance, which is typically Medicaid. But often it’s not, you can have fewer options if you have the public health insurance. So what is the payment system like? Like how is healthcare delivered in the Netherlands?
Madi van Tonder – 00:04:50:
So everyone has to have healthcare. There are a few options that you can choose from. And the packages are very similar in terms of price and what they offer. So it’s not like the one is very different than the other, but I’m not sure exactly how it works if you can’t afford it, but the rule is you need to have healthcare. So I would imagine there would be some kind of support. And the basic healthcare system includes giving birth at home or giving birth at a hospital if for a medical reason. So that’s all covered by the basic package. If you do choose to go to hospital or to a birth center because of personal reasons, just because that’s where you feel safer, it depends on then the package that you have. So you can have more expensive packages that will cover it, or you will need to end up then paying for yourself.
Dr. Rebecca Dekker – 00:05:38:
Okay. And one thing that you and your colleague were explaining to me when we were in the Netherlands is that there is a right to home birth in the Netherlands or a cultural kind of valuing of it. Can you talk a little bit about that?
Madi van Tonder – 00:05:52:
Yeah. So home birth actually in, I think it was, it was in 2020 was named or claimed as a national heritage because it’s something that they are really proud of. And back in like the 1940s, about 70% of births actually happened at home. Whereas now it’s closer to for first births, it’s under 20%. So it’s becoming a lot, a lot less, but they really do want to encourage home births. So they decided to, for that reason, make it a national heritage. To see if they can promote people actually giving birth at home.
Dr. Rebecca Dekker – 00:06:27:
Okay. So it’s actually in being declared a national heritage, home birth is then considered something that everybody has the right to as long as they meet the health qualifications and that they encourage Dutch families to have home births. Correct?
Madi van Tonder – 00:06:41:
Correct. Yes.
Dr. Rebecca Dekker – 00:06:43:
Okay. What is the role of the doula in the Netherlands birth system? So if everybody has a midwife, how do doulas interact with that system?
Madi van Tonder – 00:06:54:
So yeah, the doula isn’t part of the formal system. I think it’s similar. We’re not protected titles in the Netherlands. But you see that quite often where the doula plays a big role is when you get handed from your first line of care. So from the midwifery care to hospital care, because then you also get transferred to the hospital team. And that’s where doulas offer the continuity of care for that. You also see that there are midwife centers that also have in-house doulas or that have collaborations with doulas. Because they also see the value of just having the continuity with home births. Also, you have your midwife is she is in the area driving around and then she’ll come to you when you’re close to giving birth. But then having a doula, you actually also have someone with you in the house for a few hours leading up to birth. So it just provides that security and that safety of knowing that you’re supported.
Dr. Rebecca Dekker – 00:07:51:
Okay. So hiring a doula in the Netherlands would be meaning you’re getting additional support on top of what the system provides you, but the doulas are not provided by the government.
Madi van Tonder – 00:08:02:
Exactly. Doulas are completely, if you want a doula, it’s on your own. It’s your own choice on your own cost. That’s also not covered by the healthcare system.
Dr. Rebecca Dekker – 00:08:10:
Okay. Are there different midwives in the hospitals and the homes? Are they the same midwives? How does that work?
Madi van Tonder – 00:08:17:
They are different midwives. So you get the clinical midwives in the hospital and I just call the ones in the center, just midwives. So they have slightly different roles and they’re not the same people. They have different trainings also. So you do need to get, if you have a medical reason to go to hospital, you do need to get transferred to a different midwife.
Dr. Rebecca Dekker – 00:08:37:
Yeah. Okay. So there is a transfer of care from one midwife, but it doesn’t go from a home birth midwife to the obstetrician. The transfer typically goes from the home birth midwife to the hospital midwife.
Madi van Tonder – 00:08:49:
Yes. To the hospital midwife. And then depending on what your needs are, you might then also see obstetrician or a gynecologist. Yeah.
Dr. Rebecca Dekker – 00:08:55:
Okay. And what is the Dutchwordformidwife?
Madi van Tonder – 00:09:00:
So midwife we call verloskundiges. So, and yeah, verloskundiges. And then we have also more traditional midwives that we call vroedvrouw. Or yeah, a vroedvrouw. Dutch is also not my first language.
Dr. Rebecca Dekker – 00:09:18:
Some of the pronunciation definitely can be different for an English speaker, for sure. I think one of the things that really surprises people, especially Americans, about the European healthcare system and in Scandinavian countries, like the importance of the midwives in the prenatal, antenatal, and childbirth care. Like they’re the ones admitting you to the hospital. They’re the ones taking care of you. They’re the ones kind of talking about, we need to bring the doctor in. Instead of like the other way around in the United States, the default is you see the obstetrician first, unless you specifically kind of look around and find a midwife. And then often the midwives are kind of find their actions kind of more regulated by the physicians at the hospital. But I get the feeling that the midwives have a lot more power in the Netherlands than they do in the United States.
Madi van Tonder – 00:10:11:
Yeah, definitely. It’s definitely… It’s midwife run unless there’s a reason for the midwives not to be in charge. Yeah.
Dr. Rebecca Dekker – 00:10:19:
Okay. And how does that work in terms of outcomes? Like, is there a high Cesarean rate in the Netherlands? What are you seeing like the outcomes look like where you’re living now?
Madi van Tonder – 00:10:33:
Yeah, so even with being transferred to hospital, the Dutch have a very, they often say being pregnant and giving birth is not a disease. It’s natural. And they also approach that in a very natural way. So you do have access and options to everything, but they will always try to find the most natural option first before going into. For example, with pain medication. They won’t immediately just offer an epidural. They will say, do you want to try and get in the bathtub first? Or do you want to try whatever other options they might have available first? And then, of course, if you are giving birth at home, they don’t have laughing gas or epidurals or any medicated options with them. So also choosing to give birth at home, you are essentially choosing to try and give birth as naturally as possible.
Dr. Rebecca Dekker – 00:11:24:
Okay. And what kind of comfort measures do you see used as a doula then? So you mentioned tubs, but if epidurals are less common, you know, say somebody’s planning a home birth or they’re at a birth center, what are they using to stay comfortable?
Madi van Tonder – 00:11:41:
At home, quite often, a pool, a birth tub. TENS machines are popular. I’ve seen them use the comb method and counter-pressure, especially with the doula there. A lot of counter-pressure that takes place. So yeah, aromatherapy I’ve seen. Really these different movements, changing position, those kind of things.
Dr. Rebecca Dekker – 00:12:02:
Okay, so a lot of the non-medication comfort measures. And then do people use some of these methods as well in hospital?
Madi van Tonder – 00:12:11:
Oh, definitely. Yeah. So most hospitals have rooms that have bathtubs. I’m saying most hospitals where I am or you have. You have access to a tub if you’re lucky. And if you don’t need to be monitored, you can always try that. But they do also encourage changing positions, using a TENS machine. These kind of things are definitely encouraged even if you are in hospital.
Dr. Rebecca Dekker – 00:12:33:
Okay. So if you’re walking in the hospital with a client, they’re not going to say, when do you want your epidural?
Madi van Tonder – 00:12:40:
No, definitely not.
Dr. Rebecca Dekker – 00:12:42:
What are some of the first things they say to your clients in labor?
Madi van Tonder – 00:12:46:
Well, they ask first, they will say, how are you feeling? And is this comfortable for you? And then they will, based on the situation, quite often the client will ask if there’s an option for a bathtub, but they will say maybe they have a ball. Do you want to sit on the ball? Or did you bring a ball to sit on? Those kinds of things.
Dr. Rebecca Dekker – 00:13:05:
Yeah. Okay. So it’s really focused on their comfort, even though they’re not focused on pain medication. Yeah, exactly. And how is the concept of having an epidural or other medications for pain relief? Is it becoming more common or are the Dutch still kind of trying to stay away from it whenever possible?
Madi van Tonder – 00:13:24:
I don’t know if it’s statistically becoming more common, but especially when I speak to pregnant women and I work with a lot of expats more than Dutch people. That idea of not having access to an epidural if I wanted is you see that quite often. And I think that also plays a role in seeing the drop of how many people have argued doing home births, that it is that they prefer to just be close to an option if possible. Yeah. In terms of whether it’s going up or not, I’m not sure about that, but it’s definitely accessible.
Dr. Rebecca Dekker – 00:13:57:
Okay,yeah. So you can have an epidural if you want. And you’re saying some of the people who have immigrated to the area or are living in the area, not from there originally may be choosing the pain medications more often.
Madi van Tonder – 00:14:09:
Yeah. Yeah. You see that happening.
Dr. Rebecca Dekker – 00:14:11:
Okay. Talk to me about, you know, the actual birth, because we’ve talked a little bit about prenatal care and labor. When it’s getting time for the baby to be born when their head is almost to come out? Like what happens in the Netherlands typically? Because in the United States, the classic, which you often see in the movies, is they have the woman lying on her back in bed, maybe feet in stirrups. They put a big light shining on the perineum. The doctor may like do perineal massage as the baby’s head is coming out. So it’s kind of like a high intervention, usually a back lying or semi sitting position. What does it look like in the Netherlands? What’s the routine?
Madi van Tonder – 00:14:54:
I would say that it’s quite mixed because what you just explained, I have seen that. But it often also follows after having tried other things. So if you’re in a bathtub, I’ve seen women being allowed to be on all fours in the bathtub and like really hands off, allowing them to push and follow their body. And-
Dr. Rebecca Dekker – 00:15:16:
So water birth can happen in the hospitals?
Madi van Tonder – 00:15:18:
This is at home.
Dr. Rebecca Dekker – 00:15:19:
Oh, at home. Okay.
Madi van Tonder – 00:15:20:
In hospital, it can happen again, depending on the reason why mom is there and what the medical if and what the medical reason would be.
Dr. Rebecca Dekker – 00:15:27:
Okay.
Madi van Tonder – 00:15:28:
Yes. At home, they tend to be more hands off though than in hospitals. They will often also like side-lying is they try, like to try quite often first all fours. They do allow the mom to also say how she feels, but you do often see that the mom ends up on her back in hospital just because of whatever reason for the doctors to be able to see because mom says she feels more comfortable.
Dr. Rebecca Dekker – 00:15:54:
Yeah. Okay. So it sounds like it’s easier to kind of protect the options of upright birth when you’re out of the hospital.
Madi van Tonder – 00:16:03:
Yeah, definitely.
Dr. Rebecca Dekker – 00:16:04:
When you get into the hospital, there’s often more medical reasons for being there. So there’s more interventions.
Madi van Tonder – 00:16:10:
Exactly.
Dr. Rebecca Dekker – 00:16:11:
What about after the birth? So how long do parents, if they’re having a hospital birth, how long do they stay in the hospital?
Madi van Tonder – 00:16:18:
So if everyone is fine, mom is fine, baby is fine, they go home after two hours.
Dr. Rebecca Dekker – 00:16:25:
Wow.
Madi van Tonder – 00:16:25:
Yeah. They just get checked, make sure, do all the checks, and then they can go home. But yeah, if there was anything, for whatever reason, they have different protocols. So if baby is a little bit too light for the date of the birth, they need to stay to be monitored for 24 hours. If antibiotics was given, they need to stay. If mom lost too much blood, they have different protocols also on the amount of time and the checks that they do.
Dr. Rebecca Dekker – 00:16:51:
Yeah. So you have to meet certain criteria. But if you do, most parents are said, all right, you can go home now. Two hours later.
Madi van Tonder – 00:16:58:
Yeah. Yeah.
Dr. Rebecca Dekker – 00:16:59:
Okay. And do your clients, do they like that? Are they excited to go home? Do they wish they could stay longer?
Madi van Tonder – 00:17:05:
The expats quite often want to stay longer because just, I think the unknown, especially if you’re a first time mom, they feel that at least there’s a medical team around them. More often than not. I’ve seen that there is also a reason to stay longer. Also because quite often when I am in hospital, it is also for a medical reason. You also have the choice to stay if you want to, but that is then on your own cost. Healthcare won’t cover that.
Dr. Rebecca Dekker – 00:17:33:
Okay. So you have to pay out of pocket if you want to stay. Longer. Okay. So tell our listeners a little bit about what is Kraamzorg. I’m not sure if I pronounced it correctly. What is this and how does it support new parents after the birth of a new baby?
Madi van Tonder – 00:17:53:
So Kraamzorg, I think, is an amazing concept that they have here in the Netherlands. It translates just for the listeners. It translates to maternity nurse is the word we use quite often here. And it is depending again on a few things, but you get about eight or 10 days after birth that they come to your house for a few hours, whether that it can be four or eight, again, depending on your insurance and depending on how the birth went. But they are then just in your house. They’re supporting you. They have a list of things that they need to do that also goes into the system for you and your child. But they’re just there to make sure that your first week with starting with the baby goes well and that they can support you when and where you need it.
Dr. Rebecca Dekker – 00:18:36:
So then you literally have a nurse come to your home.
Madi van Tonder – 00:18:39:
Basically, yes. And everyone has the right to Kraamzorg. You don’t have to take it if you don’t want to, but everyone has the right to a minimum amount of hours.
Dr. Rebecca Dekker – 00:18:49:
So over the first eight days of your baby’s life, you have a nurse four hours a day?
Madi van Tonder – 00:18:54:
Yes, minimum four, usually maximum eight.
Dr. Rebecca Dekker – 00:18:59:
And what does the nurse do for you? Like, how does that support the family?
Madi van Tonder – 00:19:02:
I think for new parents, at least, but even for second parents, they are there to help around the house, firstly, to check that things are okay. But they check up on mom to see if she’s healing well. They check up on baby, if baby is feeding well. If there are breastfeeding issues, they help with breastfeeding. It depends a little bit on what the needs are. And as I said, they do have certain things that they do need to check and that they do need to put into the system. But it is mainly just to make sure that once they leave after the eight days, that mom and dad has enough tools to be able to carry on and feel safe with what they’re doing.
Dr. Rebecca Dekker – 00:19:40:
Okay. So it sounds like parents go home early, but then they get basically daily visits from a nurse. So it’s not like you’re being left to-
Madi van Tonder – 00:19:51:
No, exactly.
Dr. Rebecca Dekker – 00:19:52:
On your own. Yeah. Are there any other practices in the Netherlands for the postpartum period that you think are beneficial?
Madi van Tonder – 00:20:01:
Yes, there’s paternal leave and maternal leave. The maternity leave is 16 weeks, four weeks before birth and 10 weeks after birth, at least. So it depends also on how long before or after your due date you give birth. The dad also gets a few days. He doesn’t get as many. And they have quite a few rules and a few laws on different types of paternal and maternal leave. And it depends a little bit on your company also. But dad gets at least five days minimum with the child. And then something that they do that I think is really good is that parents can take up to a certain age and up to a certain amount of days. They can ask for what we call a mama dag and a papa dag, which is a mommy day and a daddy day. You will see that a lot of parents of young kids only work four days a week.
Dr. Rebecca Dekker – 00:20:52:
For up to how long?
Madi van Tonder – 00:20:53:
It depends on how they take it. It’s for the first three, four,fiveyears of the kid’s life because you can choose to split it up one day a week. Some parents like to take it all in one go so they don’t go back to work for the first year, but then they need to go back full time.
Dr. Rebecca Dekker – 00:21:11:
That reminds me of when we were having coffee in Haarlem. We were sitting outside on the patio and a dad came with a toddler, I think a little child, and just sat and had his coffee with his little one and a half year old sitting at the table across from him and gave him a little drink for him. And it was so cute. And we saw that everywhere we went. We saw dads playing with their very little children, toddlers at the playground. So you’re saying some of these fathers may work, but they get a day off a week to just be with their children.
Madi van Tonder – 00:21:45:
Exactly. And it isn’t paid. There are options. Like I said, they have a few different laws. There are options that for mom, it might be paid partly, but for the most part, it isn’t paid, but they have to be given the day if they want it because daycare is quite expensive in the Netherlands. So a lot of parents choose to have mom take one day, dad take one day, and then they have less days that they have to takethebaby.
Dr. Rebecca Dekker – 00:22:09:
They have to pay for childcare.
Madi van Tonder – 00:22:11:
Yes, exactly. Okay.
Dr. Rebecca Dekker – 00:22:12:
Okay. And I was looking at some statistics before we started. The postpartum care that you were talking about earlier with the special aid who comes to your house, that’s fully covered by your Dutch health insurance as well.
Madi van Tonder – 00:22:29:
There might be a small like own risk, they call it, payment that you need to make, but in the most part is covered by healthcare. Yeah.
Dr. Rebecca Dekker – 00:22:36:
Okay.
Madi van Tonder – 00:22:37:
Yeah. I don’t know if it’s similar. It’s similar because with healthcare here comes with, you pay a certain amount and then you have a certain amount of, they call it own risk. So the first amount you get paid out of your pocket, and then once you’ve hit the ceiling to that, it goes into being paid by the healthcare.
Dr. Rebecca Dekker – 00:22:54:
So it’s my understanding that in the Netherlands, like much of Europe is struggling with immigration and many countries around the world are. I would imagine that has brought some challenges to maternity care and birth work. Are there any challenges related that you want to talk about or any other struggles you’re seeing? Even though it seems like from our perspective, it’s like, wow, the Netherlands has this amazing health care system. What are some of the things that need improvement?
Madi van Tonder – 00:23:20:
So one thing that you hear quite often is the fact that. Sometimes the protocol is quite strict and I think it’s relative for us compared to the US, for example, but that you do sometimes hear that people feel, why are these protocols here? And that sometimes without a good enough reason, moms will need to. So, for example, if you’re pregnant with twins, you have to give birth in hospital. But if mom is doing well and babies are doing well. Why can’t they give birth at home? Like these kind of things are always discussions that you hear are being had. In terms of the immigration, I actually saw on the news the other day that they were saying what was quite difficult was to… monitor and have a record of refugees coming in because they are being moved around without updating midwives so that they do go for their checks or they don’t get their scans when they need to because they’re kind of falling in between the cracks. That’s something that I actually by chance happened to see on the news this week. So it’s definitely something that you hear about and that’s being talked about.
Dr. Rebecca Dekker – 00:24:28:
So it sounds like there’s communication issues with kind of like an influx of new pregnant patients for the healthcare system and trying to… You know, assign them to midwives and make sure they’re not losing communication with them.
Madi van Tonder – 00:24:41:
Exactly. Yeah. And I think it’s probably a bigger issue than just pregnancy. It’s the big influx of a lot of people and the Netherlands is, and Europe is still figuring out where they can stay. So then the movement, it influences all parts, but also maternal care.
Dr. Rebecca Dekker – 00:24:59:
What about language barriers for immigrants?
Madi van Tonder – 00:25:03:
Dutch people speak English really well. So if the immigrants do have an understanding of English, it tends to work out fairly okay. But yes, of course, if you have someone that comes in that doesn’t speak English and you don’t speak their language, then yes, finding translators, this is definitely difficult.
Dr. Rebecca Dekker – 00:25:25:
Is there anything else you want to share, Madi, about your work as a doula in the Netherlands? Any stories or any contrasts with where you, you know, your knowledge of the system in South Africa or anything else you want to talk about?
Madi van Tonder – 00:25:39:
Well, I think something that comes up quite often, and we mentioned it quickly, but we didn’t go into detail about that, is that in the Netherlands, you can’t choose to have a Cesarean. You can only have one if there’s a medical reason to have one. And that’s something that quite when I speak to expat women, especially coming from countries like South Africa, where the Cesarean rate is quite high and other countries that. They’re not really happy about that, but this is part of the low intervention philosophy that the Netherlands has. So you also see that the Cesarean rate is really low. I think it’s about 16% of which half is planned. So that’s something that, especially when I speak to expats, that’s one of the questions they do ask me is, what if I want a Cesarean? And then they also ask about the epidural, but I already mentioned that they always have the option for an epidural if it’s available.
Dr. Rebecca Dekker – 00:26:28:
Okay, but you can’t choose a Cesarean unless it’s medically necessary.
Madi van Tonder – 00:26:33:
Exactly, yeah.
Dr. Rebecca Dekker – 00:26:34:
What about repeat Cesareans? So let’s say you had your first child by Cesarean. Do they require you to attempt a vaginal birth after Cesarean, or can you have a repeat Cesarean?
Madi van Tonder – 00:26:45:
You are given the choice to have a repeat. They encourage the VBAC, but if you don’t want to, then the chances are good that you’ll be able to give birth by Cesarean then.
Dr. Rebecca Dekker – 00:26:57:
Okay. I guess thinking of other interventions, one thing we’ve talked a lot about on the Evidence Based Birth® podcast is elective induction at 39 weeks. It’s become very popular with obstetricians in the United States, and I’m hearing reports of some other countries. So can you request an elective induction before your due date in the Netherlands, or is that not allowed either?
Madi van Tonder – 00:27:20:
You can ask and depending on the situation. You might be given induction before your due date. I also know for medical reasons, they will sometimes also induce you anyway before your due date. But elective induction here is at 41 weeks is usually the time that they look at, okay, what do you want to do moving forward? It’s not 39.
Dr. Rebecca Dekker – 00:27:42:
So they’re not routinely suggesting to their patients, you should be induced, it’s 39 weeks or 40 weeks.
Madi van Tonder – 00:27:49:
No, this is some discussion they start having at 41 weeks. And then you always have an option. They can’t make you do anything they can suggest, but in the end, the parents still have the right to say no if they don’t want to.
Dr. Rebecca Dekker – 00:28:03:
Okay, so they probably recommend an induction at 41 weeks, but they can’t require you to.
Madi van Tonder – 00:28:09:
Exactly.
Dr. Rebecca Dekker – 00:28:09:
Okay, you can still say no and you can keep waiting for labor to start on its own. And with all of these, it’s just so fascinating to see that the Netherlands has such good birth outcomes, a very low Cesarean rate of 16, to 17%. And they’re not doing a lot of the things that, you know, American physicians are pushing right now, like the elective inductions at 39 weeks. Instead, it seems like they’re focused on the midwife model of care, on supporting birth as like a wellness event rather than an illness, unless there’s a complication. Does that sound about right to you?
Madi van Tonder – 00:28:47:
Yeah, that’s exactly that. And like I said, this is one of my favorite things that I hear that they say, when you’re pregnant, you’re not ill. It’s natural. So we approach this naturally. Yeah.
Dr. Rebecca Dekker – 00:28:57:
Mm-hmm. And do you feel like women and birthing people in the Netherlands, do they trust in their bodies? Like, do they trust in their ability to give birth smoothly? Or is there a lot of fear related to childbirth?
Madi van Tonder – 00:29:11:
I think, again, it’s mixed and it depends a little bit on who you speak to, but there’s definitely, at least from what I’m used to seeing back home, there is a lot more awareness in knowing your body and understanding your body, listening to your body. A lot of the midwife centers do free childbirth education classes. You’ll need to pay for it, but pregnancy yoga is very popular. So definitely the holistic natural side of pregnancy and birth, it’s definitely something that you see a lot here and that’s really encouraged.
Dr. Rebecca Dekker – 00:29:41:
What about nurses? You know, we talked about their potential role postpartum, but are there labor and delivery nurses in the hospitals like we have in the States or not?
Madi van Tonder – 00:29:51:
Yeah. So in the hospital, you will have a nurse that will be the one that will come in and check up on you every few hours. And she will be the one that calls the doctor or the midwife when needed. And if you give birth at home, the Kraamzorg will come and assist the midwife when you deliver.
Dr. Rebecca Dekker – 00:30:06:
Okay. Yeah. Wow. Well, it’s been really eye-opening and fascinating to talk with youMadi, and hear about just the differences in the system. And you said this is a pretty big contrast for you too, coming from South Africa, correct?
Madi van Tonder – 00:30:21:
Yes, definitely. When I was living in South Africa, I was still a student, so I wasn’t in the birth world, but most people you knew either was born by C-section or they were giving birth, it was very likely that it would be a Cesarean. So I already knew it was a lot of intervention. And then also coming here and starting to do the research. Yeah. I always find it interesting that you have the data and everyone has the same data and that people, that you still see differences that are so big in different countries.
Dr. Rebecca Dekker – 00:30:50:
Yeah. Are there any takeaway lessons you think someone listening might learn? Say they’re giving birth in a very high intervention culture where there’s not as many options. What’s something, that people can learn from how birth is done in the Netherlands.
Madi van Tonder – 00:31:08:
I would say that if you know your options, because even here, I can see birth hardly ever goes the way that the people plan, but they know their options and they know their rights and they are allowed to say no. And the medical staff also need to respect that. And I don’t know if that is as acceptable in the US, for example, but just to know that you have a say and you have a right, but that if you know what your options are, you have a better idea of what’s going on.
Dr. Rebecca Dekker – 00:31:37:
Yeah.
Madi van Tonder – 00:31:37:
Yeah.
Dr. Rebecca Dekker – 00:31:37:
So education is power in whatever system, healthcare system you’re in.
Madi van Tonder – 00:31:42:
Exactly. Education is power. Yeah, definitely.
Dr. Rebecca Dekker – 00:31:46:
Well, thank you, Madi. It was so wonderful talking with you again. I appreciate you and yeah, Bedankt.
Madi van Tonder – 00:31:51:
Yeah, as you believed. And thank you for, yeah, thank you for giving me this opportunity. It’s been really great.
Dr. Rebecca Dekker – 00:31:57:
Thanks, everyone, for listening. Bye. Doei, doei. Today’s podcast episode was brought to you by the online workshops for birth professionals taught by Evidence Based Birth® instructors. We have an amazing group of EBB instructors from around the world who can provide you with live, interactive, continuing education workshops that are fully online. We designed Savvy Birth Pro workshops to help birth professionals who are feeling stressed by the limitations of the healthcare system. Our instructors also teach the popular Comfort Measures for Birth Professionals and Labor and Delivery Nurses workshop. If you are a nurse or birth professional who wants instruction in massage, upright birthing positions, acupressure for pain relief, and more, you will love the Comfort Measures Workshop. Visit ebbirth.com/events to find a list of upcoming online workshops.
