What Expat Mothers in Amsterdam Wish They Had Known Before Giving Birth
- Ayu Doula Ombretta
- 3 hours ago
- 12 min read
An honest, practical guide to navigating the Dutch maternity system — from someone who has been in the room
Last reviewed: July 2026
There is a particular kind of loneliness that comes with being pregnant in a foreign country.
You are navigating one of the most significant experiences of your life — and you are doing it without the people who know you best, in a system that works differently from anything you have encountered before, sometimes in a language that is not your own.
I have been supporting expat families in Amsterdam since 2019. The women I work with come from the United Kingdom, the United States, Italy, Australia, Brazil, India and dozens of other countries. They are intelligent, resourceful, well-prepared women. And almost all of them, somewhere in the final weeks of pregnancy or in the days after birth, say some version of the same thing:
I wish someone had told me this earlier.
This post is that conversation — the one I have with every expat client in our first prenatal session, covering the things that the official guides do not always say clearly enough.
1. The Dutch System Is Not What You Are Used To — and That Is Not Necessarily a Bad Thing
Many expats are taken aback by the non-interventionist approach to perinatal care in the Netherlands. If you come from a country where pregnancy is managed primarily by an obstetrician, where scans happen every few weeks and where hospitals are the default birth setting — the Dutch approach will feel different.
In the Netherlands, a healthy, low-risk pregnancy is managed by a primary care midwife (verloskundige) — not a doctor. You will not automatically see a gynaecologist unless your pregnancy develops a complication or risk factor that requires specialist care. Your midwife will handle your prenatal appointments, your birth and your immediate postpartum care.
It is a common misconception that all Dutch mothers have home births. In fact, only about 21% of women have their babies at home. The majority of deliveries happen in a hospital, under the guidance of a midwife or a gynaecologist.
You have three choices for where to give birth:
At home — attended by your midwife and a maternity nurse (kraamverzorgster). Safe for low-risk pregnancies and the choice of roughly one in five Dutch women and an increasing amount of expats that want to birth in an environment that supports birth physiology, with little or no interruptions or interventions and as natural (hormone driven) as possible. There are many pro to this birth location - provided you have a support team that is prepared to offer continuous physical and emotional support and your home meets accessibility requirements in case an urgent transfer is needed. When I work with women towards home birth - for their first or subsequent birth - the focus is on creating emotional resilience and trust in the process, coach their partner so that they are prepared to a journey with no pain medication and work during pregnancy together to prepare the body and the mind, practicing laboring positions, breathing technique and comfort measures. We use TENS, rebozo shifting, spinning babies, prenatal yoga and mindfulness as I hold them in this beautiful and transformational the process. Midwives are fully prepared to offer support in this setting managing a number of mothers and baby emergency and suggest a transfer if medically appropriate.
At a birth centre (geboortecentrum) — some women with a low risk pregnancy prefer to birth with their midwife and a maternity nurse (kraamverzorgster) in one of the birth centres. Different reasons: sometimes is the lack of space in their home, sometimes they prefer not to be heard by neighbours, sometimes is because their apartments do not meet the regulations for accessibility or because they would like to be as close as possible to an hospital. In Amsterdam the main facilities are Bevalcentum Oost (inside OLVG Oost) and Bevalcentrum Zuid a free standing facility. One of the other reasons women opt for birth centers is the possibility to have access to laughing gas (nitrous oxide) as pain relief or have access to water birth without stress. The preparation is the same.
In hospital — some women just feel safer in a setting that can provide urgent care when needed. If you have a low risk pregnancy you can still give birth in the hospital with your midwife - the care is transferred to the second line midwife the moment you require pain relief, an IV or augmentation to mention a few. Sometimes the care is transferred to the hospital already during pregnancy if a risk factor is detected, if your labor starts before week 37, you are planning a TOLAC/VBAC, if a medical or elective induction is on the horizon, your baby is breech or a casarean is planned or becomes a need while in labor. Here the preparation may vary the moment you have already decided to opt for an epidural as not having access to freedom of movement requires passive adjustments of the pelvis and release of the tissues to help baby descending and rotating in the middle pelvis as well as a different management of the pushing stage.
None of these is the right answer for everyone. What matters is that you understand your options clearly and make a genuinely informed choice — not one driven by unfamiliarity or assumption.
2. Pain Management Works Differently Here — Know This Before You Are in Labour
This is the piece of information that surprises expat mothers most — and that matters most to understand before labour begins rather than in the middle of it.
Dutch doctors want to medicalise birth as little as possible. This philosophical position extends to pain management. In the Netherlands, an epidural is not automatically offered — you have to request it, and depending on where you give birth, it may not be immediately available.
If you are planning a home birth or a birth centre birth, an epidural is not available at all. If you transfer to hospital during labour, requesting an epidural involves a clinical assessment and, depending on how far along you are, it may or may not be possible by the time it is administered.
This is not the system withholding something from you. It reflects a genuine cultural and medical philosophy around physiological birth — one that has produced outcomes that compare favourably with countries where epidural rates are significantly higher.
But if you come from a country where an epidural is considered a routine option available on request — the United States, the United Kingdom, Australia — this difference can feel shocking in the moment if you have not prepared for it.
What this means in practice:
Have an honest conversation with your midwife early in pregnancy about pain management options available at your chosen birth setting
Understand what non-pharmacological pain management looks like — water, movement, breathing, positioning, the support of a doula — and prepare for it practically, not just theoretically
If an epidural is important to you, make sure you are planning a hospital birth and discuss with your midwife exactly what the process for requesting one looks like at your specific hospital and to have the understanding of how it affects baby's rotation in your pelvis and how this can be supported
Know that wanting pain relief is not a failure — and that not wanting it is equally valid. What matters is that you have thought about it before you are in labour, not during it
Learn about remifentanil patient-controlled anesthesia: an opioid that can be administered on later stages of dilation.
3. Your Partner's Role Is Different Here — And They Need Preparation Too
In the Dutch maternity system, the partner plays a more active role in birth than in many other countries — partly because there are fewer medical staff in the room during a home or birth centre birth, and partly because the Dutch philosophy of physiological birth places significant emphasis on the support of the people closest to the labouring woman.
Consider attending prenatal groups or courses and hire a doula who will be by your side whatever happens in the delivery room from pregnancy. It can be a real game changer in how confident you feel.
Many expat partners arrive at birth feeling underprepared — not because they have not tried, but because they have not been given the tools. What does active labour actually look like? What can they do physically to support contractions? What should they say — or not say? When should they speak up to the midwife and when should they step back?
These questions have answers. But they need to be explored before labour begins — not improvised in the room.
What this means in practice:
Attend childbirth education together — not just the basic Dutch cursus but something that specifically prepares your partner for active labour support
Talk explicitly about what you want from your partner during labour — every woman is different, and your partner cannot read your mind in the intensity of contractions
Consider a doula specifically for partner support — one of the most common things partners say after a birth I have attended is: I felt we were a team, I was prepared and as you arrived I felt an immediate sense of relief
4. Language Barrier and Fear of Miscommunication
Most midwives in Amsterdam speek good english, many of them excellent. Some expat women have been in Amsterdam for years without having the need to understand Dutch beyond the basics - the question is: is this a real issue? Some providers will switch to Dutch to talk with their colleagues or with your partner, if he is Dutch. It is just so easy as reminding them to speak with you in English if this happens, they will adapt. Sometimes I wonder if the fear behind language barrier is that there is lack of trust towards your care provider: the thought that they might skip steps and parts that are important for you. It is important to remember that communication is a two ways stream: your partner - or your doula, need to make sure that the right questions are asked. Speaking the same language is not the solution to communication issues: feeling the right to ask them and knowing what and when to ask is the real key. I have been in the birthing space for over 7 years now, as English speaking doula, and while my understanding of dutch allows me to follow conversations quite well, even then, with my Dutch clients the need to ask more questions is part of the job. So if you are concerned about this - remind them again, print out your birth plan in english and in dutch and make sure you keep on asking questions until all is clear. Use B.R.A.I.N. to make your decision around interventions - be sure you have clear what are the medical reasons (benefits and risks), what are the alternatives, what are the risk and benefits of taking time and do try with your birth partner or your doula a change in position and follow your intuition.
5. The Kraamzorg System Is Wonderful — and It Ends Faster Than You Think
New mothers in the Netherlands have few complaints with the high level of postnatal care, which includes personal help at home covered by Dutch health insurance.
Kraamzorg — the Dutch postnatal care system — is genuinely one of the most remarkable things about giving birth in the Netherlands. A trained maternity nurse comes to your home for eight to ten days after your baby is born, typically for several hours each day. She supports the baby's care, monitors your recovery, helps with breastfeeding, takes care of light household tasks.
For expat mothers, especially those without family nearby, this is often a lifeline.
And then it ends.
On day eight or ten, the kraamverzorgster leaves. And for many expat women — far from their mothers, their sisters, their usual support network — this is when the real postpartum begins. The exhaustion deepens. The questions multiply. The confidence that someone is watching over you disappears. And the expectation, subtle but relentless, is that you should be managing by now.
The postpartum gap — the weeks between the end of kraamzorg and when a woman genuinely feels like herself again — is one of the least discussed and most significant challenges of giving birth in the Netherlands as an expat.
What to do about this:
Plan for postpartum support before your baby arrives, not after — it is almost impossible to research and arrange in the exhausted first days
Know that postpartum doula support and Ayurvedic postpartum home visits exist as options beyond kraamzorg — specifically designed to fill this gap
Reach out to expat mother communities — Amsterdam Mamas, Peanut, Mamamoon, local parent groups — before your baby arrives so you have connection in place when you need it
Be honest with yourself about what you will need — most expat mothers underestimate this, because they are used to being independent and capable. Postpartum is not the time to prove that
If you can, ask for your mother or sister to come to stay with you — this is for many women I serve a conflicting choice: they would love support and yet the most common fear is related to boundaries. If you opt for this, consider to have a conversation prior to their arrival, make sure you have the space to host them either at your place or somewhere nearby and that they are able to find their way around in the city and are able to speak english so that you don't have to worry of taking care of them
6. The Three-Tier System Can Be Confusing — Here Is How It Actually Works
The Dutch maternity system operates on three levels — and understanding this before you are in it helps enormously.
First line (eerste lijn): primary midwifery care. This is where most low-risk pregnancies are managed. Your primary midwife is your main care provider throughout pregnancy, birth and the immediate postpartum period.
Second line (tweede lijn): hospital care with a clinical midwife. If your pregnancy develops a complication or risk factor, you may be referred to a clinical midwife working within a hospital setting, often alongside a gynaecologist.
Third line (derde lijn): specialist obstetric care. For pregnancies with significant medical complexity — premature labour, severe pre-eclampsia, fetal growth restriction — care is managed by a specialist team in a hospital setting.
The transfer between lines can happen during pregnancy or during labour. Many expat mothers find the concept of transferring from a home birth or birth centre to a hospital during labour unsettling — it can feel like something has gone wrong. It is worth understanding that transfer is a routine part of the system, not a failure. Home births in the Netherlands are considered safe for low-risk pregnancies, and midwives are well-equipped to handle them. When transfer does happen, it happens because the system is working as designed — moving you to the level of care your situation requires.
7. Register Your Baby — and Know Your Parental Leave Rights
This is the practical information that nobody tells you until you need it.
Birth registration (aangifte van geboorte) must be done within three days of birth at the local municipality (gemeente). You will need your passport, your partner's passport if applicable, your marriage certificate if applicable, and the birth declaration from your midwife or hospital.
Maternity leave: New birth mothers in the Netherlands are entitled to pregnancy leave of four to six weeks before the birth and maternity leave of ten to twelve weeks after — both at 100% of your day rate.
Partner leave: Partners are entitled to five weeks of paternity leave, for which they receive 70% of their regular pay — unless their employer supplements to full pay. This is shorter than many expat partners expect, particularly those from Scandinavian countries or the UK where partner leave policies are more generous.
Health insurance: your baby needs to be registered with a Dutch health insurer within four months of birth. This is often forgotten in the fog of the newborn period — set a reminder before your baby arrives.
8. Build Your Village Before You Need It
This is the advice I give every expat client — and the one that is hardest to act on when you are pregnant and tired and still trying to find your feet in a new country.
Being pregnant away from home, in an alien maternity system, can be daunting. The women who navigate it most smoothly are almost always the ones who built their support network before their baby arrived — not the ones who waited until they needed it.
This does not mean you need to know everyone. It means having a few key people and resources in place before your due date:
An English-speaking midwife practice you trust and feel comfortable with
A doula who speaks your language and understands the system
At least one or two other expat mothers at a similar stage — prenatal yoga classes (we have a wonderful community at Yoga Circle and Bluebirds where most of the teachers are also doulas and childbirth educators), Mamamoon Village (through Mamamoon App), Peanut App and other local groups
A postpartum support plan — what happens after kraamzorg ends, who is coming, what is in place
You do not need to have everything figured out. You need enough in place that you are not starting from scratch in the hardest weeks of your life.
A Final Word
The Dutch maternity system is genuinely good. The midwifery care is skilled and respectful. The kraamzorg is a gift. The philosophy of trusting birth as a physiological process — rather than a medical emergency waiting to happen — produces outcomes that speak for themselves.
What it is not designed for is the specific experience of navigating it without your village, in a language that is not your mother tongue, in a city that is still becoming home.
That gap is real. And it is exactly the gap that a doula — specifically an English-speaking doula with deep knowledge of the Dutch system — is designed to fill.
If you are pregnant in Amsterdam and any of this has resonated — I would love to have a conversation. The intro call is free, there is no pressure, and it costs nothing to talk.
Ombretta is a birth doula, childbirth educator and Ayurvedic practitioner and Postpartum Doula based in Amsterdam. She has been supporting Dutch and expat families through birth, postpartum and the transitions of womanhood since 2019 — in English and Italian.
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