The birth story, and another Mexian-American-Amsterdammer in the world

Welcome to the world, Ayla.

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20150921_103225It’s weeks after the birth. I did it. I guess that’s the thing about being pregnant, no matter what, at some point it ends, whether you’re ready or not.

I get why women are pregnant for 40 (or more) weeks now – because even for those of us who really loved the whole pregnancy experience, sometime toward the end even I was like “ok, that’s enough now, labor and delivery seems like a small price to pay for being able to roll over in bed again.”

I started meeting with my midwife more often, and one-on-one, in the last few weeks. She came to my house for our meetings, which was perfect. Like most of my prenatal care, 99% of the time I spent with my midwife during those meetings was talking, and then she’d do a check for blood pressure, heart rate, and baby’s position. There were no internal exams, or checking to see if I was already dilating. In the 39th week, my blood pressure started to go up – I think it was 135/85 – and my midwife expressed a small concern that the baby didn’t seem to be growing so much (these are two warning signs that the placenta might not be doing the job properly). A couple days later she returned to check on both of those things, and luckily my blood pressure was down to 120/80 – still up there, but nothing to be concerned about for a heavily pregnant woman. As for the baby, she said “you know what, it seems like you’ll have a small baby. but he/she is fine.” The baby was exactly in the right head-down position and engaged, I felt lots of movement, heart rate was perfect, and all was good.

20150828_163549I went into labor two days after my due date. The days around my due date were pretty fantastic. I never felt very hormonally charged during the pregnancy (maybe I acted hormonal, but I didn’t feel it), but all of a sudden I felt really, really charged. One day I was so absurdly happy and in such a great mood, I was smiling and saying hello to everyone on the street, as if Amsterdam was a small midwestern American town. Another day I felt really, really closed off and introspective. Everything just felt like more. On day 40+1, Enrique and I went out for a long, luxurious lunch. We walked for a couple hours. I felt massively pregnant, but I wasn’t having any contractions.

40 + 1

29 August 2015

On day 40+2, August 29th, I woke up around 5.30am after having slept about 3 hours (sleeping was not easy in the last month of pregnancy)… and saw that I had some pink discharge. Ah! The bloody show! I knew this was a sign that labor could be on the way, but I also knew “on the way” could mean days away. Then I felt…. something. Discomfort, something I might consider a stomach cramp… or was that a contraction? I tried to go back to sleep, but it wasn’t working. It was a warm, beautiful, sunny morning, and I was in a good mood. I went to the bathroom again and saw a more obvious “bloody show,” so I got up and dressed. I felt excited and nervous and tired and calm all at the same time. I took a short shower and a 20-minute walk by myself while Enrique slept. I loved having Amsterdam all to myself – well, all to myself and the fish guys who were opening the store for the day.

And this is where I started taking notes (I jotted everything down in a notebook), which is why I know the precise times.

7am: The shower and walk both felt good. I fixed myself breakfast (oatmeal, banana, juice, one egg, a few sips of coffee). I thought I could tell when a contraction was starting and stopping, but they were only lasting between 15-30 seconds…. and I still wasn’t 100% convinced I was feeling contractions and not just stomach discomfort. You know the feeling of needing to poop? It was like that, except it would come and go.

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6am-ish in Amsterdam, 29 August 2015

7.30am: Enrique was awake and happy, but both of us trying not to get too excited that this was the real deal. I was getting tired – I really had only slept a few hours during the night – and decided to try relaxing in bed with my ipad. As soon as I was back in bed, the “contractions” slowed down and then stopped. I fell back asleep from about 8am-11am, which turned out to be the greatest thing in the world.

12:30pm: Awake. Feeling great. Ate lunch (cheese & avocado sandwich) and drank a coffee. Organized the day a bit with Enrique, wrote some emails. Felt incredibly well-rested, more so than I had in days. I was mentally prepared for labor, but I was also ok with the thought that today might not be the day after all.

1.30pm: Enrique left to go do some errands. I hung out in garden, which was super sunny and warm. I noticed I started feeling some small crampy feelings again. It really didn’t feel like period cramps at all, more like needing-to-poop cramps.

20150829_1313392:30pm: Enrique was back home, and I was pretty sure that the contractions had returned. I still felt ok, but around this time it became hard to do other things, like sit down comfortably and read. Enrique and I were both kind of like “ok, so, this is labor? ok, cool. ouch! breathe, breathe. ok. fine.”

3:00pm: went on a 30 minute walk with Enrique. Ran into our neighbors, realized it was getting difficult (and simply not appealing) to have a conversation while a contraction was coming over me. Started to be able to identify the clear start and stop of each contraction, and they seemed… maybe 6 minutes apart or so? All still a bit hard to say, but walking felt good.

4:30pm: First call to my midwife, as I was now pretty sure I was in legit labor, though still not totally convinced. I could still talk through contractions, but I was getting more and more uncomfortable. Sitting or laying down wasn’t remotely an option. The feeling of the contractions was a very low, deep in my body,  type pain. I was still seeing blood and fluid when I went to the bathroom. I turned off the relaxing yoga-ish music that Enrique had put on and started listening to some old pop-punk favorites instead. Much better. I tried to find some sort of comfortable spot in the house, or position. Nothing felt right other than walking and leaning against the wall at times.

6:00pm: Enrique made a small meal – cous cous with veggies. We started timing the contractions, and discovered that between 5:53pm and 6:41pm they were on average 44 seconds long, about 4 minutes apart (thank you, contraction app!). Even though all the evidence was in front of me, I still wasn’t 100% it was real labor. The contractions were very uncomfortable, but I wouldn’t say they hurt, or were so painful. Just very uncomfortable. I walked around my apartment and sang along with all the Mr T Experience songs on the “Love is Dead” album and vowed to call my midwife again when singing along became too hard.

7:00pm: I called my midwife again from the bathtub. It was getting harder to talk through the contractions but I wouldn’t say it was impossible. She kept me on the phone for awhile longer and said I sounded like I was in labor, and that I should just keep doing what I’m doing, and to let her know when I felt like I wanted her to show up.

8:00pm: Called my midwife again with the “ok, come over now” request. At this point I felt like I was no longer comfortable in my apartment, as the only thing that I really wanted to do was to walk. Walking around a small apartment was starting to make me crazy, and I was getting tired – I wanted to find a new position but couldn’t come up with anything. She came right over, and called the birthing center on her way, so they would be prepared (assuming that I was indeed in real labor and ready to leave home).

8:45pm: Midwife arrived at my house and I felt a huge sense of relief. I was ready to give over some control of the situation and take instruction. She checked my dilation, and I mentally prepared myself to hear that I was only 2cm dilated, just in case. After all, it hadn’t been that long, and the pain was still manageable. Turned out I was 5cm!!! Best news ever. She made a few calls, and we all left for the birth center in her car.

9:30pm: Beyond relieved to be at the birthing center. I admit when I got in the car, a part of me was hoping that the whole car trip/arrival at a new location would slow down my contractions, like I had heard. Turns out, nope. Not really. As I walked in, I had to lean over the reception counter and let a contraction pass before I could go any further. Whew.  Once I was in the room I felt so, so happy that I was there. I immediately took off all my clothes, got into the giant tub (which they had started filling with water from the time my midwife called), and felt a huge sense of relief in the water. The setting was perfect, it was just me, Enrique, and my midwife. The room was dimly lit, there were candles, maybe we put on music – I don’t quite remember.

Time started to blur here. I would say I was in the tub for maybe 45 minutes, maybe an hour or longer. The contractions were starting to get pretty serious and much more painful, and I felt (like I had heard it described) as if I needed to take the world’s biggest poop. I decided to get out of the tub and labor on the toilet a while (which was conveniently next to the tub), which worked great. I felt like I was “allowed” to release there, which I think helped unleash all the real action. We weren’t timing anything, but there was much less time between contractions, and they were a lot more intense. Throughout everything, my midwife was monitoring the baby’s heart rate with a handheld doppler, every 15 minutes or so, and Enrique was always right there with me.

Sitting on the toilet became uncomfortable (it was a bit high off the ground), so I switched to the birthing stool. This was perfect. I was on the stool, Enrique was sitting behind me, and I was grasping on to him for dear life and I felt his support. Midwife in front of me. The entire time, she just kept telling me “you’re doing great, listen to your body, go with what you feel, this is going great.” Occasionally she would try to steer me in a certain direction, telling me to try and go toward the pain, and work with it. She was saying this during the most painful parts, when the contractions were really, really intense. Probably around… 11pm. Each contraction was taking over my entire body and just… I don’t know, I felt like everything just wanted to come out, like my eyeballs were ready to pop out of my face and I might throw up. It was a little scary! Her guidance kept me calm between the contractions, and during the contractions, well, I was a screamer.

But I was focused. I could hear her advice, and I could take it. I would repeat her words. “Open, open, going toward the pain,” and stuff like that. I didn’t quite get that I was actually ready to push until she told me a few times in a gentle way “listen to your body, it’s ok to push if you want.” Push? Like push the baby out? Wait, really? After a particularly painful contraction that made me feel like all my limbs were ready to detach themselves from my body, I asked “is this transition?” And she said “This is you delivering the baby, you are ready, just go with what your body is telling you.”

Holy crap. I know, she had said that a few times, but I … I didn’t quite get it! This all hurt a lot, sure, but there wasn’t a single second that I thought “I wish I had pain relief,” and I thought that I should expect even more intense pain than what I was feeling before I would be ready to push. I was using all my energy to be 100% focused on staying on top of the contractions – getting my breathing and mental state ready for when they would come – and I would try to regroup myself mentally and physically during the breaks. There wasn’t really time to think or do anything else.

According to her records, I started pushing at 11:20pm, so only two hours or so after I had arrived. She had me get back in the water around this time, which was exactly the right thing to do. I was able to be on my hands and knees in the tub, which allowed my body to feel like everything was pointing in the right direction. On the birthing stool I had been fighting the urge to throw up, but once I was on my hands and knees, I was 100% focused on pushing and the urge to vomit passed. I am still so grateful that she advised me to do this – because my head was down (there was a towel under my forehead, so I could place it on the edge of the tub against the wall) I was also able to block out looking around at anything else and just focus on the voices of my midwife and Enrique.

I could feel everything so vividly. I could feel the baby’s head come down the birth canal. I could feel the crowning. I could feel her slide back and forth as I tried to push her out – still quite overwhelmed by what I was doing, but feeling incredibly supported and confident with my midwife and Enrique cheering me on. At some point, the midwife had Enrique change his position with hers (they were both outside the tub, leaning over), and put his hands in the water to get ready to receive his daughter. I was aware all this was happening but still completely in disbelief that I was minutes away from delivering.

At the end, I realized I needed to push not only when the contractions were hitting, but also during the “rest.” No one really explained this to me, but I was getting the sense from the way my midwife and Enrique were encouraging me to push that I really should make every effort to get her out, and so I did. Even with all this craziness going on, it was amazing that I still had so much control over how my body was working. Finally, her head came out under the water, and Enrique’s hand was there to catch her. She opened her eyes (this was all told to me, of course) and looked up at him through the water. Two more contractions later, her body came out – god I still remember how that felt. It felt amazing. Painful but… it all felt like it made sense. It was so much to take in and manage, but it was all logical. I know that’s a weird word to use, but that’s the best way I can describe it. And there was so, so much relief.

As she fully exited my body, Enrique’s hands were still holding her. While I tried to process what I just did, the midwife unwrapped the cord from her neck (it was wrapped around one time) while she was still under the water. I turned over into a sitting position, kind of tangled up in the umbilical cord, and it was then that I could exclaim “It’s a GIRL!!” The most perfect little girl, with a head full of dark hair, crying with her amazing little voice. She was placed immediately in my hands, and against my body.

It was insane. I felt like it all happened so fast, but I had no real concept of time, so if someone had told me it had taken 20 hours I would have believed it I believed it.. but in the end my labor was approximately 2.30pm-12.20am, or ten hours. And there I was, with my daughter in my arms, finally meeting her. All I said at first was “oh my god, it’s a girl, it’s Ayla, hello baby.” After just a few minutes I got out of the tub with her, still attached by the cord, and was helped to the bed (which was 2 steps away). Ayla and I weren’t separated at all for the next 2-3 hours. We were both covered with blankets and made to feel as comfortable as possible, and I held her next to my body the entire time. I delivered the placenta with her on my chest. I was checked for tearing with her on my chest (no tearing, and no stitches!). After about an hour or so, we started breastfeeding. It was perfect. The entire situation was just perfect – I couldn’t have scripted it better if I tried.

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An hour or so after the birth, 31 August 2015

We were bought a plate of food and I drank about 15 liters of water and juice (man I was thirsty!) while she laid against me. We didn’t cut the cord from the placenta for a few hours, because there just didn’t seem to be a reason to. The placenta delivery was easy (maybe because I had a wonderful little baby in my arms to distract me!) – I pushed, felt a cramp, and it was out. My midwife showed Enrique and I the placenta, and explained where Ayla had been, and what it had done for us. These hours were amazing.

Around 4am or so, I wanted to get up and shower and move around a bit. I was sore and slightly light-headed, but I was able to get out of bed, shower, walk, get myself dressed (with help), and get back in bed to cuddle with Enrique and Ayla some more. And then we all left, around 5.30am. We could have stayed longer, and it was lovely there, but we wanted to be home. So we packed the bags, called a taxi, put Ayla in the carseat, and walked outside. It was still dark, but just starting to get some hints of daylight. The moon was so big and full. Drunk people were riding by on their bikes, laughing. It felt so perfect to be outside in the fresh air, in the middle of such a beautiful city, on the day of my daughter’s birth.

And then we arrived home, around 6am, and everything about my new life started.

20150907_204537 20150923_140855 IMG_3924 20150919_160838 IMG_3970Ayla Xochitl
Born 30 August 2015 at 12:20am in Amsterdam, The Netherlands
Weight: 2960 grams/6.5 lbs
Length: 50 cm/20 inches

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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.

Having a baby in Amsterdam: the first trimester, and how to get started

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.

 

Apparently, I’m having a baby in Amsterdam

After an amazing six weeks in Mexico, followed by two weeks in New York City, I returned home to Amsterdam in late January. I bought a bottle of Trader Joe’s folic acid pills with me. I was about 8 weeks pregnant – first pregnancy, first baby.

My main residence for the past seven years has been Amsterdam, though my commitment level to the city has waxed and waned over the years. The first 3-ish years, I was super committed. I spent a lot of time, energy (and money) to sponsor myself for a visa that allowed me the right to work as a freelancer, and gathered enough clients to support myself with work. I built up a great community of friends and built a pretty solid home base. Even though I lived in Florence for a couple of months, I always knew that would be a temporary thing.

After about 4 years or so, I was in a slump with Amsterdam. The weather, man. It wears on a person after that many years. Work was going well, but did I really want to work in advertising forever? I never learned the Dutch because I honestly never really cared enough to learn the language – doesn’t that say something? I mean, I left the Netherlands for two months in order to study Italian for 30+ hours a week in Italy for two months (for no real reason), but I don’t think I can say I spent 30 hours in five years trying to learn Dutch. Plus: my partner, the person I was in a committed long-term relationship with, had the exact same commitment issues I did with Amsterdam… only his were even worse. He had been coming and going since the late ’90s, but never really planning to live here long-term (even though one could argue that 12+ years in a city is fairly long term). We both spent a year in Mexico in 2012-2013, and contemplated making that a permanent re-location.

But there was always that thing that Amsterdam could do… give me one beautiful spring/summer/fall day here and suddenly I have no idea why I ever thought about leaving in the first place. The bikes, the friends, the weirdos, the seemingly unlimited amount of things to do which were all completely accessible and affordable, the absurd beauty of the city itself and all those canals… this is what has kept me around, and part of what bought us back. So it’s weird that even now, after 7 years of paying taxes in the Netherlands, I never really integrated myself into the culture. Amsterdam never needed me to integrate in order to give me an amazing life.

The neverending summer skies in Amsterdam. Living around so much water is wonderful.

The never-ending summer skies in Amsterdam. Living around so much water is wonderful.

Summertime in a city park in Amsterdam

Summertime in a city park in Amsterdam

Shouldn’t that be a complete shame? When I lived in Paris, I had french friends (along with a lot of foreign friends, sure). I struggled daily to speak French, but I always did when I was out. I took classes, I learned about the food, the culture, the people, the traditions, the “rules.” I greeted every bus driver with a “bonjour”, accepted that bread, jam, coffee, and juice was a full breakfast that for some reason cost €8, and learned to always inquire on discounts for being under 26-years old, for anything. Later on, during the two months I spent in Italy, I enjoyed learning about Italian culture and adapting to the Italian way of doing things. I traveled on the slow trains to save money, realized it was possible to (at least try) charm my way out of or into situations, and never drank cappuccino after 11am. The more I learned the language, the more doors opened up to me, and I loved it. In Mexico I did the same thing. I ate huge lunches and light dinners, I learned Mexican slang, expressions, and food. I put chili and lime on ice cream. I made friends with Mexicans who don’t have any idea what my personality is like in English. I became interested and involved in Mexican stuff – the holidays, traditions, etc. Every time I moved to a new country, the more I immersed myself in the culture, the richer my experience became.

Mexican Lunch in Puebla - enchiladas

This is about 4x the size of an average Dutch lunch. It was not hard to adjust.

I don’t know why that’s not true in the Netherlands. I have about a million more thoughts about the topic, but for now I’ll just leave it as a fact: my life in Amsterdam is amazing, rich, full of love, but I am in absolutely no way living a “Dutch” lifestyle, if one can even say there is a “dutch” lifestyle in Amsterdam (and let’s be clear: Amsterdam is Amsterdam, and in no way representative of Dutch culture as a whole in the Netherlands). Well, I can ride a broken-down bicycle over a sheet of ice in the rain while carrying a dining room chair, but other than that, I’ve chosen to entirely disregard a lot of the traditions, culture, and customs here.

I do love the poffertjes (small, thick pancakes) available in the markets

I also love the poffertjes (small, thick pancakes) available in the markets.

And yet Enrique and I are buying an apartment and having our baby in Amsterdam. I’m 22 weeks (more than halfway there!) pregnant, and both of us knew from the minute that pregnancy test turned positive that we would have the baby in Amsterdam. So. There was a lot – a LOT – to learn. The reality of having a baby super far from our families started to seem a little weird. What about cousins, uncles, aunts, grandmas and grandpas? I thought about my own childhood, and how much I absolutely adored and loved both sets of my grandparents. I’m used to living abroad, to maintaining my childhood friendships with visits every few years and skype and emails. But I’m completely missing getting to know my niece and nephew (1 & 3) in California, and now my baby will miss getting to know his or her cousins. Whew. But ok, breathe. My kid is also going to have a million advantages. He or she will grow up tri-lingual, in a city where being a tri-lingual six-year-old isn’t really even that weird. He/she will grow up in a really safe, beautiful city where the system more or less works (at least it works better than it would in the US or Mexico) – we’ll always have access to health care and schools. Both Enrique and I have friends with kids, and we’ll make more. We’ll learn Dutch, dammit, this time for real. My kid will grow up with a passport from birth (I got my first passport when I was 21), and will travel to new countries and continents as a normal part of life. He or she will be riding a bike (with me or Enrique) from a few months old. We’ll make visits back to our home countries and our families will come to visit us. We’ll rent out our apartment when we travel to subsidize our plane tickets.

It's stuff like this that can make a place feel like home, even if it is pouring rain outside.

It’s stuff like this that can make a place feel like home, even if it is pouring rain outside.

Those are among the types of thoughts I had in January and February, during my first trimester.

I was nervous. Nervous about approaching the Dutch medical system after spending so many years as an outsider. Nervous, suddenly, that not speaking the language would be a huge disadvantage. Nervous because there are so many stories from foreigners about their (negative) experiences. However, I couldn’t shake the feeling that I was so insanely lucky. This baby was indeed a wanted baby, and I didn’t have any issues getting pregnant. I wasn’t sick at all during my whole first trimester. I knock wood as I write, this, but I’m having (so far) a completely easy, fun, exciting pregnancy… so there’s a huge reason to feel lucky.

Beyond that, I have been abroad for almost ten years now, and I don’t have one idea in my head that “this is the way it works” when you’re pregnant – and I think this is an advantage. I didn’t witness a lot of friends having kids in the US – or if I did, it was from afar. I do not think that the US or Mexico are shining, fantastic examples of countries that Do It Right. So I told myself to be open. Be open to the Dutch Way. See how it goes. Take it one step at a time. Start at the beginning. Wait, so where do I even begin?

Ok, number one: find a midwife.