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?

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.

News
Russell Brand was in typically combative form during his promotional interview with Newsnight's Evan Davis
peopleReports that Brand could stand for Mayor on an 'anti-politics' ticket
News
The clocks go forward an hour at 1am on Sunday 30 March
news
Arts and Entertainment
The Doctor finds himself in a forest version of London in Doctor Who episode 'In the Forest of the Night'
TVReview: Is the Doctor ever going stop frowning? Apparently not.
News
Voluminous silk drawers were worn by Queen Victoria
newsThe silk underwear is part of a growing trade in celebrity smalls
PROMOTED VIDEO
Life and Style
ebooksA superb mix of recipes serving up the freshest of local produce in a delicious range of styles
Life and Style
ebooksFrom the lifespan of a slug to the distance to the Sun: answers to 500 questions from readers
Sport
footballMatch report: Real fight back to ruin Argentinian's debut
News
Candidates with surnames that start with an A have an electoral advantage
newsVoters are biased towards names with letters near start of alphabet
Arts and Entertainment
Isis with Lord Grantham (Hugh Bonneville)
TV
Arts and Entertainment
Jay James
TVReview: Performances were stale and cheesier than a chunk of Blue Stilton left out for a month
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Maths Teacher

    £110 - £200 per day: Randstad Education Leeds: Secondary Maths Teacher for spe...

    Business Analyst - Surrey - Permanent - Up to £50k DOE

    £40000 - £50000 Per Annum Excellent benefits: Clearwater People Solutions Ltd:...

    ***ASP.NET Developer - Cheshire - £35k - Permanent***

    £30000 - £35000 Per Annum Excellent benefits: Clearwater People Solutions Ltd:...

    ***Solutions Architect*** - Brighton - £40k - Permanent

    £35000 - £40000 Per Annum Excellent benefits: Clearwater People Solutions Ltd:...

    Day In a Page

    Wilko Johnson, now the bad news: musician splits with manager after police investigate assault claims

    Wilko Johnson, now the bad news

    Former Dr Feelgood splits with manager after police investigate assault claims
    Mark Udall: The Democrat Senator with a fight on his hands ahead of the US midterm elections

    Mark Udall: The Democrat Senator with a fight on his hands

    The Senator for Colorado is for gay rights, for abortion rights – and in the Republicans’ sights as they threaten to take control of the Senate next month
    New discoveries show more contact between far-flung prehistoric humans than had been thought

    New discoveries show more contact between far-flung prehistoric humans than had been thought

    Evidence found of contact between Easter Islanders and South America
    Cerys Matthews reveals how her uncle taped 150 interviews for a biography of Dylan Thomas

    Cerys Matthews on Dylan Thomas

    The singer reveals how her uncle taped 150 interviews for a biography of the famous Welsh poet
    DIY is not fun and we've finally realised this as a nation

    Homebase closures: 'DIY is not fun'

    Homebase has announced the closure of one in four of its stores. Nick Harding, who never did know his awl from his elbow, is glad to see the back of DIY
    The Battle of the Five Armies: Air New Zealand releases new Hobbit-inspired in-flight video

    Air New Zealand's wizard in-flight video

    The airline has released a new Hobbit-inspired clip dubbed "The most epic safety video ever made"
    Pumpkin spice is the flavour of the month - but can you stomach the sweetness?

    Pumpkin spice is the flavour of the month

    The combination of cinnamon, clove, nutmeg (and no actual pumpkin), now flavours everything from lattes to cream cheese in the US
    11 best sonic skincare brushes

    11 best sonic skincare brushes

    Forget the flannel - take skincare to the next level by using your favourite cleanser with a sonic facial brush
    Paul Scholes column: I'm not worried about Manchester United's defence - Chelsea test can be the making of Phil Jones and Marcos Rojo

    Paul Scholes column

    I'm not worried about Manchester United's defence - Chelsea test can be the making of Jones and Rojo
    Frank Warren: Boxing has its problems but in all my time I've never seen a crooked fight

    Frank Warren: Boxing has its problems but in all my time I've never seen a crooked fight

    While other sports are stalked by corruption, we are an easy target for the critics
    Jamie Roberts exclusive interview: 'I'm a man of my word – I'll stay in Paris'

    Jamie Roberts: 'I'm a man of my word – I'll stay in Paris'

    Wales centre says he’s not coming home but is looking to establish himself at Racing Métro
    How could three tourists have been battered within an inch of their lives by a burglar in a plush London hotel?

    A crime that reveals London's dark heart

    How could three tourists have been battered within an inch of their lives by a burglar in a plush London hotel?