Recently, an American friend told me the story of her stressful drive to a clinic for a routine checkup several days after giving birth. It was January in Wisconsin, and her car slid down the icy highway while her newborn wailed in the backseat. She wore a giant sanitary pad and had wedged a pillow beneath her aching pelvis.
In the Netherlands, where I have lived as an American-born-and-raised expat for four years and given birth twice, such a situation would be unlikely. This is because of the Dutch practice of kraamzorg, postnatal maternity care that takes place in the home rather than a clinic or hospital. During the first eight days after a woman gives birth in the Netherlands, she receives a standard 49 hours of care from a kraamverzorgster, or maternity aid, paid for by the basic health insurance held by all residents. This equates to about six hours per day of in-home care, ranging from physical checks of the mother and baby to housecleaning, assistance with breastfeeding, and training in basic infant care. My own births were fairly straightforward, and I was satisfied with 49 hours of care, but in more complicated cases, families may also request an extra two days of kraamzorg.
Kraamverzorgsters are not midwives or registered nurses, but they do have three years of post-secondary training to prepare them for their important work. Although some kraamzorg duties are standard, such as weighing the newborn and keeping the mother’s bed and bathroom clean, many kraamverzorgsters bring something unique to the table. During my two postnatal periods, I was cared for by a no-nonsense mother of two who taught me to breastfeed while walking around so I could be more mobile. Another of my kraamverzorgsters vacuumed the entire house each afternoon while I napped. My favorite, a grandmotherly Amsterdam native, spent hours playing with my toddler, grocery shopping, and cooking us nutritious dinners before she left each night. I cried at the end of the week when she presented us with a tiny hat she had knit for my daughter. My relationships with these women were short but full of human kindness.
The kraamzorg service is not high-tech. It provides the kind of practical help an experienced mother might dole out, and it speaks to the Dutch beliefs that birth is a natural occurrence and that families should be integrated into a social system that nurtures their long-term well-being. Kraamverzorgsters are representatives from the “outside world” who enter into the inner sphere of the family. Along similar lines, almost all children up to 4 years old participate in a free city-based system of vaccinations and well-child visits. This multi-level system initiates a sense of belonging within the local social structures and provides a means for social workers to intervene sooner for families in need.
Somewhat counterintuitively, the kraamzorg system can also keep healthcare costs down by shortening post-birth hospital stays. It is very common in the Netherlands for parents and babies to leave the hospital within hours of the birth. While it may seem jarring to kick mothers and babies out of the hospital in the middle of the night, new parents can be secure in the knowledge that a kraamverzorgster will be at their house by the next morning.
Occasionally, I hear from moms who feel uncomfortable with the idea of strangers in their houses after birth. The kraamzorg system is definitely not perfect. Parents can find kraamverzorgsters privately, but most people, including me, use kraamzorg agencies that employ many workers. Depending on the time of year and busyness of the period, a family might have several different kraamverzorgsters during the postnatal week. Families often have little choice in which kraamverzorgsters they receive, and some of the workers are better than others. Still, most people I know have had extremely positive experiences with their kraamzorg. Particularly for immigrants, like myself, or those who simply lack extended family nearby, the system provides guidance to ease parents into their new roles. And, of course, the kraamverzorgsters, coupled with midwives and social service employees who visit the home, prevent new mothers from having to venture out with their newborns during the first tender days. No new mother should have to drive through the snow several days post-birth to have her stitches removed.
New parenthood is notoriously stressful, but the kraamzorg system provides a buffer against some of the anxiety of those first few days. My own memories of the first weeks of motherhood are of a cocoon of care—that all took place at home.