It was mid-January, and I was hanging out in a small apartment in Brooklyn, eating an absolutely delicious bagel and trying to figure out how one goes about this whole having-a-baby thing. I had probably already eaten a big bowl of cereal as well, I was ravenous and about 7 weeks pregnant. My situation felt a bit surreal – sitting in New York (where I’m from) and trying to figure out how to get started with the whole pregnancy thing in Amsterdam. It wasn’t as if I could ask my other New Yorker friends for their advice, and I felt a bit disconnected from Amsterdam (after being away for almost 7 weeks at that point on an extended vacation). I started with what I knew.
In the Netherlands, the default is working with a midwife, not an ob/gyn. The idea is that doctors are for sick people, and pregnant women (with low-risk pregnancies) are not sick. This sounds painfully practical (in that so-dutch way), and …. well, it makes a lot of sense. If you can get behind this idea without too much effort, the first step – after you’ve confirmed pregnancy – is to pick a midwife. I think the general rule of thumb is that the first visit happens around 8-10 weeks, but you might want to go in for “consultation” meetings before that (where you just learn about the practice, etc.).
But how?? How does one just pick a midwife? Are there rules? Isn’t this a super-important decision? Will I be able to find a midwife that is okay with speaking English? Where do I even begin? This is all covered by my dutch health care insurance, right? What kind of insurance do I have, anyway? Just a few of the question that ran through my mind as I watched the snow fall in New York.
I googled for awhile, and then I gathered up the guts to email one of my non-dutch-mom-friends in Amsterdam to tell her that I was pregnant and had no idea how to get started and to please give me advice. This was well before I was comfortable spreading the news of pregnancy, but really, you’ve got to have a bit of help. My mom-friend responded quickly with all sorts of really helpful information, and google filled in the rest.
The rule about picking a midwife is pretty simple: pick one close to your house that you like. Do some research, see which midwife practices appeal to you, and see if you can have an “intro” no-commitment meeting (that I refer to as a consultation). Very do-able, right? I started researching. I used google Chrome a lot when looking at midwife websites for instant translations. I learned some things that I didn’t like, and decided to stay away from them. For instance, the idea of going to a midwife practice where I would see a different midwife every time? Not appealing at all. 15-minute meetings once a month with a variety of different care providers was not my idea of pre-natal care, and even though some other expat-type blogs had me believe that was The Way It Works, I figured that surely there would be a midwife practice that suits my needs. And indeed there was – I discovered Vive Vroedvrouw, and immediately loved what I read on their english language page. Right there, in perfect english, was a description of “typical” midwife care in the NL (“group practices, usually with around 4-5 midwives …a lot of different faces during your pregnancy … a fair chance of hardly knowing the midwife who will attend your birth … The consultations last 10 to 15 minutes maximum“). And then there was a description of the care that they offer and why. The parts that mattered most to me at the beginning was simply “One personal (primary) midwife instead of various midwives as seen in a group practice….Each prenatal appointment will be 60 mins, ensuring more than enough time to pay attention to any emotional, and where desired, spiritual aspects of your pregnancy.”
I sent an email to their general address, telling them when I thought I was expecting and asking a few questions. I didn’t get a reply, so I sent another email directly to a few of the individual midwives listed on the contact page. I had a reply from within a couple days from a midwife telling me she was available to have a consultation meeting around the start of my 9th week of pregnancy. She would be able to refer me for an ultrasound at this meeting as well, and Enrique was more than welcome to join. I told myself to calm down and be patient (ha!) and that there was nothing wrong with waiting until the 9th week for this consultation meeting, even though in the US the idea is that women go to their OB/GYN pretty much as soon as they find out they have a positive pregnancy test. To be honest, the consultation meeting couldn’t really happen any earlier, since I was out of town. I decided not to schedule any other consultations while I was still in NYC, that it would be better to have the first one and see what it was like.
I flew back to Amsterdam on the 20th of January, and a few days later Enrique and I went together for the consultation. This was all so completely new and weird for us, but I had a really good feeling from the beginning, just being at the WG-plein in the Oud West. Crazily enough, it was at a party in the WG-plein where I had first met Enrique. The Oud West was one of the first neighborhoods that I really knew in Amsterdam. The office was close to my house (1.5 km away – a six minute bike ride or 20 minute walk). So far, so good.
The three of us met in a small, comfortable room. We sat on pillows on the floor and were offered tea. We spoke for a little over an hour, and I asked as many questions as I could think of. She gave me a few books (in english) about the pregnancy process in the Netherlands (this was so valuable!). We didn’t make any commitments that day – Enrique and I went home to think about it, and decided pretty easily that we were quite happy with the practice and with the midwife we had met. Fortunately, she also agreed that we would be nice clients to work with, and the deal was set. I had a midwife. A sweet, Dutch midwife who had worked with many other foreigners before, and who seemed to love her job. I chose to work with her because that’s what felt right at the time – there really isn’t much more to it than that and I decided there wasn’t any reason to over-complicate things by visiting other places. At the consultation, she had written me a referral for three ultrasounds – one at nine weeks, one for 12 weeks, and one for 20 weeks. All ultrasounds in the Netherlands are optional, so if you don’t want them, no one will force you to have one. My insurance covered the first and the 20-week ultrasound, but I had to pay for the 12-week “combination test” ultrasound out of pocket since I was under 36 years old (I missed the age limit by about six months). The combination test was about €150. But let’s stay on track and go in order.
That first ultrasound… I was so nervous. I was nervous for days beforehand, I was nervous that day, and I was nervous about everything. Like – name the most remote possibility on earth, and I can assure you I thought of it and dedicated time to being nervous about it. I was 9 weeks and 5 days when I walked into the Echo Amsterdam office.
Like most people in Amsterdam, the woman who greeted me at the office was absolutely fine with speaking english. I gave her my referral, told her my name and birthdate, and showed her my insurance card. About 3 minutes later, Enrique and I were called in the room. I don’t remember much about the details – I remember being surprised that it was a trans-vaginal scan (“to see the baby more easily” explained the tech), but later learned that this is entirely normal at the early stages of pregnancy when the baby is still so small. And then I remember holding Enrique’s hand very tightly and seeing up there on a huge screen the evidence I had been so incredibly eager to see: there was the baby! A few minutes later, we heard the heartbeat. We saw movement. The tech took measurements, pointed things out, and told us everything looked perfectly normal. After we wiped the happy tears out of our eyes and collected the printed photos (and digital copies on a USB), I saw another woman who quickly and expertly drew blood that would be used for the combination test in two weeks time. I was on a pregnancy high for at least another week or so – Enrique and I must have stared at those ultrasound photos for hours. It all finally seemed real.
My next midwife appointment took place when I was 11 1/2 weeks along, and this was my first “official” appointment. This time my midwife asked me detailed questions about my health, my history, took my blood pressure, and also took a sample of blood. Enrique joined me again for this one too, and we spent a good amount of time talking about the upcoming combination test scan, what kind of results we may get, etc. By the time this appointment had rolled around, my pregnancy “high” was in a battle with pregnancy paranoia. I saw the 12 week ultrasound as another big benchmark to cross, and looming in the near future was that magical 14-week mark, where the first trimester is over. I doubt I’m the first pregnant lady to feel paranoid about “what if….”, and I bought up some of those “what if” thoughts at the appointment. We chatted about everything, and she listened patiently and assured me that even by 11 1/2 weeks, my chances at miscarrying were already incredibly low. She was entirely unconcerned about my age (35). This appointment lasted well over an hour, and Enrique and I left feeling great. This was exactly the kind of pre-natal care I wanted and needed. I never felt rushed, and I felt that my midwife did care about me as a person, not just “patient 9837.” Again, I’m positive she has heard the same paranoid thoughts from hundreds of women in the past – but she never made me ridiculous or just brushed me off with literature.
I’ll be talking more about how valuable this part of pre-natal care has been through the whole process later on.
I went for ultrasound #2 when I was 12 weeks and 3 days, and everything on the scan was perfect. The baby really looked like a baby, and less like a tadpole (the head was more proportional to the body and we could see legs). They checked for markers of down syndrome and saw nothing visibly alarming about the development. Here’s where I’m going to get a bit emotional: seeing the baby up on the screen moving around and hearing the heartbeat was all I needed to see/hear to know that no matter what, everything was absolutely perfect. It was maybe my first moment of having a significantly strong feeling of just “knowing” something. When we got ready to leave the office, the tech explained that if the combination tests came back from the lab with nothing to be concerned about, the results would be sent directly to be via postal mail in roughly five days. If there was anything at all to worry about, they would send the results instead to my midwife, who would contact me to explain everything. As I mentioned previously, I had to pay about €150 for this test, which included the scan, bloodwork, and lab results. If you are over 36 years old, your insurance plan should cover this test completely.
I don’t know why, but I wasn’t worried at all. I didn’t obsessively check the mail. I didn’t worry that every time my phone rang it was bad news. I knew everything was fine. Just three days later my test results came in the mail (combination testing means a combination of the scan, my blood, and my age), confirming I was right. A 1/5000 chance of this, a 1/2500 of that – basically, we seemed to be in the clear. I very much appreciated that the letters were sent to me in english so I didn’t have to go through the process of translating anything – I never specifically thought to request this, but was grateful that someone along the way thought to put that request in.
Everything I mentioned above is more about the logistics. Now here’s a bit more about how it all felt.
During my first trimester, I didn’t feel so much more tired than I normally feel in the dead middle of winter when it’s dark and cold outside. My “symptoms” included bigger (and very sensitive) boobs and needing to pee a lot more during the night for about 2 months. And sure, those two months of needing to pee 4 times a night weren’t fun – it was pretty annoying to never get a full night of sleep. But that was really the extent of “signs that I am pregnant.” I never really had morning sickness or threw up, just a few weeks of very low-grade nausea that was usually solved by eating and relaxing a bit. Even that low-grade nausea was gone by my 9th week… honestly, if I had no idea I was pregnant, it was the type of nausea that I might not have even noticed. I thought it was going to be more… intense? I thought I’d maybe feel more? I also had no idea what “feeling pregnant” was supposed to feel like, I just know that I really wasn’t feeling it for the first 12 weeks. I mean really, for the first three or four months, I knew I had this little life growing inside me – I read the weekly updates from babycenter, I saw the scans, I heard the heartbeat. But I didn’t get how there could be a little life inside me with a beating heart and organs and hands and legs without me feeling any different, other than uncomfortable because I was outgrowing all the bigger bras I had bought only 1.5 months ago. I’m kinda over-emphasizing this because if you read The Internet you’ll see a bazilllion articles about morning sickness, tiredness, moodiness, and a bunch of other unpleasant things. All I really had to show for my first trimester was a new collection of bras.
Sometime around 13 weeks or so I finally started to tell my friends and extended family, and everything started to seem more real. All the early-stage paranoia started to fade away and just turn into excitement. Around 15 weeks – once I got into my second trimester – my belly started to look a bit more bump-like (at least to me and Enrique) instead of just bloated. I wasn’t comfortable in my old jeans anymore and lived in leggings and dresses, and this is when I finally started to “feel pregnant.” Even though I enjoyed my first trimester, I also had my uber-paranoid moments, my sessions with google to figure out every single possible thing that might possibly go wrong and plenty of time where I just freaked myself out for zero reason. I think that’s all really normal. The only advice I would have wanted someone to tell me is this “You’re going to be a great mother and I bet all pregnant women feel the same way. And by the way, you look wonderful.”
If you are the friend or partner of a pregnant lady and she is telling you about a feeling that seems completely absurd, please don’t tell her she’s being crazy or give her that “wow, you’re nuts” look. And don’t tell her “that will never happen,” as I promise you, she probably has three bookmarks saved where that thing did happen. Tell her what I said above. I promise that some logical part of her knows she’s being a little nuts, and I promise, this phase will pass.
My next midwife appointment was in my 13th week, and this is where things got interesting. Centering Pregnancy had started.