Understanding the Dutch Maternity Care System
If you are pregnant in the Netherlands, you may notice that maternity care works a little differently from what you are used to in other countries. The Dutch system has a strong focus on midwifery-led care. Pregnancy and birth are generally approached as normal life events rather than medical conditions. Quite a unique setup that may feel very new to you. When there are no medical concerns or increased risks, you are usually cared for by a midwife. This may be different from what you know from your home country, so it is useful to understand how the system works before your birth.
Three levels of maternity care
The Dutch healthcare system is divided into three levels of care: primary, secondary and tertiary care.
Primary care: your midwife
If you have a healthy pregnancy and there are no known medical risks, you will usually receive primary maternity care from an independent midwife. Your midwife follows your pregnancy, monitors you and your baby, and helps you prepare for birth and the postpartum period. If everything continues to develop normally, your midwife can also provide care during your birth.
In the Netherlands, you can usually choose between giving birth at home, in a birth centre or in hospital with your own midwife. The options available to you can depend on your personal situation and what is available in your area. A hospital birth without a medical indication is often called a poliklinische (polyclinical) bevalling. In this situation, you give birth in a hospital, but your own midwife remains responsible for your care. You are essentially using a hospital birth room while remaining under primary midwifery care.
Secondary care: care in hospital
Sometimes pregnancy or birth requires more specialised medical care. This can happen because of a medical concern during pregnancy, because something changes during labour, or because you need a type of care that is not available within primary midwifery care. In that situation, your midwife will refer or transfer you to secondary care in the hospital.
Hospital maternity care is provided by a team that can include clinical midwives, nurses and obstetricians (gynaecologists). Depending on your situation, different members of this team may be involved in your care. Being transferred to hospital does not necessarily mean that something is seriously wrong. It simply means that you need a different level of care or additional medical expertise. Your first-line midwife may also remain involved in your care, depending on the reason for the transfer and the arrangements between the healthcare professionals.
Tertiary care: specialised hospital care
A small number of pregnancies or births require highly specialised care because of a higher risk of complications. This is called tertiary care and is provided in specialised, usually academic, hospitals. These hospitals have additional expertise and facilities for complex pregnancies and situations that require highly specialised medical care. Your care may move between these levels during pregnancy or birth. The level of care you receive is based on your individual situation and can change if your needs change.
What does this mean for you?
One of the most important things to understand about the Dutch system is that your place of birth and your level of medical care are not necessarily the same thing. For example, you can give birth in a hospital while still receiving primary midwifery care. Or you may start your labour at home or in a birth centre and later be transferred to hospital if you or your baby need additional medical care.
A transfer is therefore not automatically a sign that something has gone wrong. It is part of how the Dutch system makes sure that you receive the appropriate care when your situation changes. Understanding this beforehand can make the process feel much less unfamiliar. It also helps you understand the conversations you may have with your midwife or other healthcare professionals during pregnancy and birth.
The more you know about how the Dutch maternity care system works, the easier it is to understand your options, ask questions and make informed choices about your own birth. During our pregnancy courses, we explain different scenario’s and how to deal with them. And regardless of the scenario; know that how you experience en remember is, is in your hands 🙂