2nd trimester, centering pregnancy, and some birth options in Amsterdam

Once I started telling more friends about the pregnancy (around the 13th week), things started to get a lot more fun. I was still feeling good physically – and after all the first-trimester paranoia started to subside, I also started to feel a lot more calm. I let the idea go that “something might happen!” and just let myself enjoy the pregnancy fully. It really was so much fun to tell people, and with every “congratulations!” I heard I felt happier and happier. I was feeling really good about my choice of midwife and optimistic about starting centering pregnancy.

Centering pregnancy is the idea that instead of meeting one-on-one with your midwife once a month for a checkup, you meet with a group of women who are all more or less in the same stage of pregnancy as you are – and the group is lead/run by midwives. These group meetings take about 2 – 2 1/2 hours, and while the midwives lead the agenda, the idea is that us pregnant ladies talk to each other and share knowledge. For me, the most important advantage was the opportunity to get to know other pregnant women in Amsterdam. Everything else about the group setting was fine, but choosing this type of environment was a decision I made 90% for social reasons. Still, I was a little apprehensive – first off, I was nervous about the language. I really, really didn’t want to be the only foreigner or be the only one who couldn’t speak Dutch. And I didn’t think it would be fair at all to ask everyone to switch to english just to accommodate me (this happens a lot in Amsterdam), I didn’t even want the idea to be suggested. I also just had no idea if I’d like it, if I’d get along with the people, if I’d enjoy the vibe. But I was optimistic, and I was really focused on all the social advantages.

In the first meeting, we realized that almost half of the group was non-dutch. Other than myself, there’s four other non-dutchies (most women are from other EU countries). The other half of the women are Dutch, and they were all completely at ease speaking English in that way that Amsterdammers are. Phew. We turned out to be a pretty diverse group – three (out of ten) were second-time moms, the rest of us were on our first baby. There are a few married couple, some long-term partnered folks (like myself), and a few who had no intention to get pregnant and had been with their current partners for very short periods of time. I learned some women had been trying for years, others were completely surprised, others had planned it all out and easily conceived when they wanted, others had a history of miscarriage, etc. Really, just in the ten of us you could see all types of pregnancies and hear ten different versions of how our births were going to be. It was yet another reminder of something you hear a lot as a pregnant woman: every pregnancy is different.

Here’s a brief rundown about how it works in my centering pregnancy meetings: There are two midwives (and one in training) for our group – the same two at every meeting. We all get a short exam with a midwife, where they check the position of the baby, listen to the heartbeat with a doppler, ask how we’re feeling, etc. We meet in a big room, so this isn’t a very private affair. This part takes about 5-10 minutes per person, depending. While everyone is taking their turns with the “exam” portion, the rest of us chat, take our blood pressure, and weigh ourselves if we want. In the Netherlands, midwives no longer routinely weigh pregnant women during checkups – there’s a scale available if we want to use it, but it’s not a “must.” Actually, nothing is a “must,” you also have the option to not hear the heartbeat. Once everyone (or almost everyone) has had their check with the midwife, we sit in a circle and start the group meeting. For everyone that didn’t get checked before the meeting, those women stay a bit later and get checked at the end. The meetings will cover about three or four topics, and we inevitably run out of time while we’re still talking. Sometimes we break into smaller groups with a list of questions to discuss, sometimes we’ll talk as one big group about certain topics. In two of our meetings, we decided to invite all the partners as well.

I’m writing this while I’m 25 weeks pregnant, and I’ve been to four centering pregnancy meetings. I had to miss one while I was on vacation, but I was able to “make it up” by having a one-on-one meeting with my midwife when I returned. Overall, I’m really, really happy with centering pregnancy – I think most of the women who chose this sort of thing have some need to be with a group of women, rather than just one-on-one with our midwives. Just having that one thing in common was enough to build upon, and I do indeed feel like I’m forming some real friendships – which will hopefully last until well after our babies are all here.

Cycling in AmsterdamAs for how my city affects my pregnancy? So far – again writing this toward the end of my second trimester – it’s pretty wonderful place to pregnant. I have been very happily surprised to discover that pregnancy and birth are really not exactly like all the stories I have heard. Let me elaborate on that…

The Netherlands is featured in pretty much any documentary or article or show about home births in the “developed” world, and often in a really positive light, making it seem like a home birth utopia from outside. From the inside, foreigners have this idea that everyone has a home birth, and everyone has a midwife, and midwives all do things only one way and if you think you might want to use an epidural everyone will tell you no and you really have to fight for your rights and man, these crazy dutch people and their lack of giving out real medicine, what is wrong with them?

Here’s a bit of how it actually is, from my perspective.

First, the health care system in the NL is far, far from perfect – and I could write pages about why that is – but if you look at the statistics it is true that this is one of the wealthiest counties in the world and the health care is top-notch. Everyone is covered by insurance, by law, and insurance covers full prenatal, birth, and postnatal care. So the NL is already starting out from a place of advantage. Second, the home birth rates in the Netherlands may be the highest in the quote-unquote developed world, but still, in 2009 it was 29% of all births that took place at home (and that number has dropped further, these days I think it’s about 20%). If you ask ten random women on the street in Amsterdam if they had a home birth, most will say no. It’s not an overwhelming majority of women that chose to give a home birth here in Amsterdam, it’s not even a slight majority. It’s a minority. However, it is very true that “midwives are the primary caregivers for all low-risk births….  the system is fully integrated with midwives and doctors working together instead of in competition” (more here). Everyone I know personally has a midwife, not an OB/GYN – but midwife does not automatically equal home birth. Home births are indeed an option, but having an un-medicated hospital birth, an epidural-assisted birth, a birthing center birth, etc., are also all options. Deciding on one thing and then changing your mind is also an option. Deciding on one thing and then having the labor go a different way is of course also something that happens. And there are so many different types of midwife practices in Amsterdam and you are allowed to chose whatever practice you want. Sure, it’s easier to pick one super close to your house. But if you want to bike a whole 3 km (or 5km, or whatever) to a practice a little further away because you liked their vibe more, that is allowed. This is such a densely populated city that it’s really hard to be “far” from a midwife practice that will work for you.

When you’re at the beginning of your pregnancy you may not understand this in such black & white terms (especially if you’re a foreigner who comes from a country where this whole “choice” thing isn’t really promoted): if you decide that you’d like to give birth at home or in a birthing center, you are also deciding to not have any strong pain medication (or medical induction with pitocin) available to you. Midwives, doulas, etc., can not administer epidurals or pitocin. They are not doctors. There are lots of unmedicated ways that midwives will teach you to deal with pain, and at the Birthing Center in Amsterdam they also offer gas (nitrous oxide) to help, but if you think that going unmedicated is not an attractive option, then your option is hospital birth. And that’s totally fine – many, many, many dutch women chose this option. Despite what we (foreigners) might have been made to believe from stories/movies/etc, hospital births with some sort of medication are routinely practiced in the Netherlands simply because that is the choice of the mother. You can be enjoying the most straight-forward, healthy, low-risk pregnancy that once could possibly have, but still deliver in a hospital with an epidural, and no one should tell you that’s not okay. That doesn’t mean you won’t work with a midwife, and it doesn’t mean it will be cold and sterile, and it doesn’t mean … anything, other than you’ll be giving birth in a hospital, where a trained anesthesiologist can give you an epidural shot if you chose to have one.

However, what you may start to feel over your pregnancy – especially if you (like me) are having zero complications, problems, or risks – is that this whole idea of unmedicated birth (at home or birthing center) starts to seem more and more attractive. And maybe that’s because your midwife tells you about 70% of her clients chose to deliver at home. Maybe it’s because you decided to visit the birth center and fell in love with the atmosphere (like me). Maybe it’s because after you’re done with the paranoid stage of pregnancy and you’re 25 weeks along and everything is going super well, you start to have more and more belief that yeah, you can totally pull off an unmedicated birth. Maybe it’s because your midwife is entirely confident (though not pushy! get rid of anyone who is pushy) about helping you through an unmedicated birth and you have built up more and more trust her her over time. Maybe you discovered hybnobirthing and believe that words like “pain” and “contraction” have no place in your pregnancy. Whatever the case may be, the choice is 100% yours. Will your midwife be a bit more biased toward one end of things? Maybe. She’s human. Are you more biased toward one end of things? Probably. Just remember, this is your birth, no one else’s. You make the decisions, and your midwife is there to support, guide, and help when needed. If you do not feel supported, then see a new midwife. Period. The huge advantage to having a baby here in Amsterdam is that you have all of these incredible options available to you – home birth, birth center, incredibly well-rated hospitals – so take advantage of the fact that you have a choice, and do what is best. If something doesn’t seem right, advocate for yourself. That same advice applies anywhere you are in the world, really, so there’s no reason for it to not apply in the Netherlands.

Road trip in Southern Spain, May 2015

Road trip in Southern Spain, May 2015 – 23 weeks pregnant

At the moment, in my 25th week of my (so far) incredibly easy pregnancy, I’ve decided I want to give birth at the Birthing Center in the Oud West. I might change my mind in week 39 – maybe I’ll decide that not having access to an epidural is way to stressful. Or maybe I’ll be so comforted in my own home and I’ll have candles and music and whatever, and I’ll decide I just want to stay home. Honestly, it’s still pretty hard to really wrap my mind around this whole giving-birth thing, and the fact that I really am going to, you know, do that. Whatever I ultimately end up deciding, I will make 100% sure that my midwife has my back and will be wherever I end up giving birth to advocate for me (my midwife practice also offers this, which is a bit more like a doula service). If for some reason I wasn’t getting this type of reassurance from my midwife, I’d probably be looking for a doula – and it seems very easy to find an english-speaking Doula in Amsterdam.

For me, these are good days. I’m getting bigger every day, and I like my belly. I’m still really comfortable cycling, though standing (still) for longer periods of time (longer than say, 3 minutes) is getting rather uncomfortable. I try to get to yoga three times a week and enjoy the nicer weather whenever the nicer weather presents itself in this city. I’ve been wearing a combination of maternity clothes and normal clothes, but I’m starting to have to put more and more of my normal clothes aside. I’m sleeping fairly well, usually getting up about once a night to pee – not so bad. I’m a bit obsessive with soaking up as much information as I can about the whole birthing process, but I’m also insanely distracted by work and buying a house, so I feel pretty balanced. Best part of all: the baby moves all the time inside me, and those kicks and twists are really one of the best feelings in the world. I’m starting to learn his or her rhythms – he/she usually falls asleep if I’m in a yoga class and doing the good, regular breathing, and then will wake up again as soon as class is ending. Sometimes it’s fine if I lay on my back, other times the baby will make it very clear that he/she is not comfortable and I need to roll over. And almost every time I get on my bike, he/she falls asleep for the ride. The idea that some months from now, I’ll be one of those moms in Amsterdam, riding my bike around with a sleeping baby in the “front seat”, makes my heart all warm. That is one of the cutest things, something I noticed 10 years ago when I came to this city as a tourist for the first time. But I get it now, a bit. I get how the babies can manage to fall asleep, even in the rain/wind/whatever, when they ride around on bikes. If they were born in Amsterdam, they’ve been doing it pretty much every day since they were a tiny embryo.

Awwwww.

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