A new approach to post-natal care: Mothers' helpers
Englishwoman Senay Boztas was wary of giving birth abroad. But the Dutch 'kraamzorg' sytem, offering one-to-one emotional and practical support, made the early days more rewarding than she could have dreamed of. Could it work here?
Tuesday 26 November 2013
Her tongue was a little heart. That was what I noticed after my daughter was born, when our midwife Judith weighed this precious, red and wriggling creature.
Maija Leena was born in a non-medical birthing unit in a Dutch hospital, with one of the midwives who helped me through the pregnancy. A couple of hours later, we were in a taxi back to our Amsterdam home.
When I started having problems with breastfeeding two days in, I didn't think about the heart-shaped tongue. Thankfully, my kraamverzorgster did. "She has a tongue tie," said Esther van der Ark, a maternity carer from the collective, Natuurlijke Kraamzorg. A kraamverzorgster is a qualified maternity nurse or healthcare professional who provides care at home to mother and baby during the first eight to 10 days after the birth. She's responsible for the recovery of the mother and the development of the baby but will also help with practical domestic things to allow the new mother to rest and recover and care for her new baby. So calmly and determinedly, Esther organised a hospital appointment to snip the membrane of skin under Maija's tongue. Minutes later, my daughter was feeding beautifully, and she still is.
This wonderful kraamverzorgster, who came to our home to help for six hours a day after Maija was born in 2011, is a normal part of Dutch postnatal care. We have mandatory private medical insurance (government-aided for those on low incomes) and everyone gets 24 to 80 hours of part-medical, part-practical kraamzorg – typically, 49 hours over eight days.
A third of Dutch women give birth at home, and the kraamzorg carer will support the midwife, clean up and stay afterwards. Otherwise, she arrives later that day to do everything from teaching breastfeeding, demonstrating newborn care or checking the position of a woman's uterus, to shopping, making lunch and doing light housework. ("You clean the loos everywhere," Esther says matter of factly.)
Jenny Collins recalls her positive experience of kraamzorg care in the Netherlands 11 years ago: "It was like my fairy godmother coming in," she says, "and I remember thinking: why don't we have such a thing?"
Now, with midwife Jan Rogers, she has launched a private company called Kraamzorg UK to offer a practical, postnatal service in England. The company is collaborating with private maternity group My Own Midwife to offer whole-pregnancy care based at Bridgewater Hospital in Manchester. Kraamzorg UK has helped five women so far, and its packages start at £875 for 25 hours over five days.
I am English, and didn't necessarily plan to have two children abroad, especially in a country that takes a tough attitude to withstanding pain. The Dutch government had to legislate to give women "the right" to demand an epidural, and while I was offered benzodiazepines (street name: "jellies") after the stressful premature birth of my son in 2010, I wouldn't have said no to a bit of gas and air in labour.
Dutch postnatal care is a different story (even though men only get two days of statutory paid leave). While I was ordered to bed, Esther was taking 20-month-old Ahti out on adventures, rustling up fried chicken and fennel, hoovering and cleaning – as well as dealing with Maija's mouldy umbilical cord, and reminding us how to bathe a slippery newborn.
This cosy, Dutch experience is rather different from the situation in the UK. Births are rising, and earlier this year the chief executive of the Royal College of Midwives (RCM) said maternity units are under "intense strain" with "many midwives at the end of their tether in terms of what they can tolerate", and a shortage of 5,000 people.
A recent change in EU law has now banned healthcare professionals from practising without indemnity insurance. This means no independent midwives, home-birth advocates say, because insurance providers won't cover them. There has recently been a slight fall in mothers starting breastfeeding, the first in nine years.
Most women give birth in hospital in the UK (only 2.4 per cent do so at home), and typically stay for up to 24 hours following a normal birth and at least 48 for a Caesarean. The RCM says there "isn't really a statutory amount" of postnatal care, and appointments can vary from a single telephone conversation to 10 visits over the first 10 to 28 days. The RCM is so "concerned" with the lack of postnatal care, particularly in England, that it will be launching a campaign later this year. Is this enough to deal with some women's experience of birth trauma, postnatal depression, and injuries from difficult births? Television presenter Kirstie Allsopp recently criticised the National Childbirth Trust (NCT) for being "politicised" and "dogmatic", saying its prenatal classes didn't always prepare people for a possible caesarean section.
And what happens when you get home after an emergency C-section, as 37-year-old new London mother Katherine Lucarotti did, to "discover that you can't lift anything, or you can't sit down and lots of things become impossible..."?
According to Esther, one of kraamzorg's most important functions is to help women recover. "The birth is always a little traumatic," she says, "but if you have care at home, someone who makes a cup of tea, and you can talk about it in detail and at length, that really helps to work through the stories, and bond with the baby. This role is the most important thing, and we do it naturally."
Sustained breastfeeding help around other family responsibilities is another plus. Kraamzorg UK's Janet Rogers explains: "We go in for five hours a day to see women breastfeeding, and support them. If your midwife came at 8am, the baby might be asleep and she might not be there to observe a feed."
Postnatal depression is a rising problem, she says, and breastfeeding can be a factor: "It can take several days, if not weeks, to establish breastfeeding and that causes a lot of stress, but if you have someone there to reassure you it helps."
Kraamverzorgsters say the Netherlands had a tradition of women as housewives – ergo, this home help – but this is a practical, commercial country. A British university study last year found that home births are cheapest, and here the kraamzorg is an essential part, supporting the midwife thanks to her three-year standard professional training (unlike a doula, a birth coach who doesn't have to be trained).
Siska de Rijke, founder of the Dutch kraamverzorgsters' professional association, NBvK, says that they support a woman giving birth at home or in hospital, and kraamzorg care can prevent expensive future problems. She explains: "A few days in hospital, and then just a midwife's visit at home, isn't nice for women, and it can be dangerous if they don't get enough time to rest, because it can lead to later complications like incontinence and problems with the uterus. Days in hospital are far more expensive than kraamzorg care."
There are up to 10,000 kraamverzorgsters in the Netherlands, working in large companies or small collectives (to deal with the unpredictable nature of birth). The care costs insurance companies about €43 (£36) an hour, and a mandatory contribution of just €4 an hour means rich and poor take it up.
According to Esther, there is also a social function: although there is a duty of privacy, a kraamverzorgster will "see in all of your cupboards". When there are problems such as poverty, domestic violence or alcoholism, she can persuade people to seek help, or sound an alert.
Back in the UK, one of Kraamzorg UK's first customers is glowing. Jessica Baldwin, 39, who lives in a village near Knutsford, Cheshire, was expecting a third child with a partner who couldn't take two weeks of paternity leave. "I knew I needed help to keep me sane and the house running so I could focus on me, baby and have time for our two boys," she explains.
"It was quite expensive and I wasn't sure of having a stranger in the house at such a personal time, but all my doubts were removed. Everything was taken care of, and it gave me time for my body to recover from a very speedy delivery. It was a luxury, but it would be wonderful if it was available to all new mothers, like when my mum had children and a 10-day stay in a nursing home."
Janet Blair, director at My Own Midwife, welcomes the Kraamzorg UK service to give her clients a "total package of care". We wonder whether the English equivalent term might be a wise woman. "I think everyone wants a wise woman to look after them," she says.
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