Wednesday, February 13, 2008

Kraamzorg

People often want to know how life in the Netherlands compares to the U.S. My first inclination is to draw attention to the basic similarities in terms of both material and ideational cultures. They are, after all, both modern Western capitalist democratic societies. We have electricity, automobiles, stores, communication technologies, etc. These aspects of material culture are certainly not deterministic of other facets of the lifeworld, but their presence does create a basic similarity with other modernized places. Furthermore,we share the same basic ideational culture that orbits around the same centers of gravity - liberty, justice, tolerance, and consumption. So, one response is that life is much the same, and it is just the details that vary (e.g., Orval in place of Fat Tire).

But this is not the whole story, because there are more fundamental differences at work. Of course, there is language (though this is mitigated by the widespread mastery of English in the Netherlands) and there is politics (the polder model of collaboration versus a two-party model that seems to mire down in divisveness). A bigger difference for me is land-use (the mixed-use, town-center model vs. sprawl, car-centric model).

Yet a bigger difference, made apparent only after experiencing it first-hand, are the differences in birthing models. America, like most of the rest of the developed world, has adopted the techno-medical model of childbirth. The Netherlands and Denmark are unique in possessing a formal, nation-wide midwifery model of childbirth. There are lots of differences, but just one I want to point out here is the way the midwifery model provides much greater support for after-care through the Kraamzorg. It is not a coincidence that there is no really good way to translate this into English, but it roughly means maternity nurse.

In the Netherlands you are entitled to insurance-subsidized kraamzorg, which for us meant specifically that we had our kraamzorgster, Wilma, for up to 49 hours spread across the 8 days following the birth of Gracie (she also attended the birth and assisted the midwives - she is the one who held Amber's hand when she was getting stitches and everyone else was focused on the baby). Wilma had her last day with us today and we are sad to see her go. She was such a great help. Her job is so multi-faceted that it includes everything from vacuuming, doing laundry, and doing dishes to taking the baby's temperature, helping mommy learn to breast feed, and weighing the baby. It was such a relief to have a kind, well-trained care-taker ride her bike to our home everyday and help us adjust to our new life.

One of the things that Amber especially liked was the way that Wilma would just sit and talk with her and listen to all of Ambers questions and stories about Gracie. Wilma would also teach us lots of Dutch words (though her English was, naturally, perfect) and tell us stories about the local area (her parents were born in Hengelo and she has an extended network of friends and family in the area - in fact, one of her sons works at the Twickle castle that we like to visit). It struck me that in addition to technical expertise and household help, Wilma provided emotional support as well. Of course, with Amber's mom here, we had a surplus of great help (one of the benefits of having Wilma around was that Barb could focus on cooking and baking wonderful food for us to enjoy...now that is going to be sorely missed when she has to go).

Kraamzorg is available in the U.S., but you need to be rich to afford it. I think this is one place where we as Americans have our priorities wrong. New families can really use the kind of help that Wilma provides, and the Netherlands has structured insurance policies and a broader culture around this awareness about the importance of what we Americans might call, oddly, "social capital." We sure are grateful for Wilma. Thankfully, though, we still have grandma here for a few more days to keep us well-fed and continue to impart her wisdom to us.

1 comment:

MamaFW said...

I agree! I think only 0.1% of the births in the US are home births. Birth centers are not widely available, but when they are (e.g., in New Mexico and Wisconsin) they seem to be a good alternative to the more traditional hospital setting. If one does choose a hospital, it is possible to hire a doula to attend the birth, and a postpartum doula, but, you're correct, insurance does not cover this. When we had our baby at home, insurance only covered 60% of our midwife's cost, even though her TOTAL charges were MUCH CHEAPER than a hospital birth would have been for us. Incredible. I believe that part of the problem is that health care is a for-profit system in the United States - it's more profitable if women have Cesarean births versus home births, that's for sure.