Differences between France and the Netherlands

Pregnancy care varies from one country to another, reflecting cultural, medical, and healthcare system differences. France and the Netherlands offer intriguing examples of contrasting approaches to prenatal and postnatal care. One of the key differentiators is the level of medicalization during pregnancy and childbirth, with France tending towards a more medicalized approach, while the Netherlands adopts a more natural approach, emphasizing the importance of normality in pregnancy and childbirth, with medical interventions reserved for cases with specific pathologies.

Practices vary widely in France: Pregnant women may receive care from either public or private healthcare providers. The choice between these sectors can lead to differences in the approach to pregnancy care. Public healthcare tends to favor standardized protocols and guidelines, while private care may offer more personalized options, not always for the best (pastdated protocols, stressfuls useless tests, elective c-section…)

In the Netherlands, pregnancy care is primarily led by midwives. Obstetricians are only involved in cases of pathology or complications. This approach encourages patient-centered care and follows strict national guidelines, ensuring consistent care practices and thorough control by healthcare professionals.

1. Differences during the pregnancy
2. Differences during and after childbirth

During the pregnancy

• Less emphasis on medical maging: In France, regular ultrasound scans are common during pregnancy. The Netherlands, on the other hand, places less emphasis on frequent ultrasounds, typically conducting fewer scans unless there is a specific medical need. This reflects the Dutch preference for a less interventional approach. In France there are, in most cases, one ultrasound per trimester (and maybe one extra at the very beginning of the pregnancy). In the Netherlands, there is no ultrasound during the last trimester, unless medically needed.
• Differences in Non-Invasive Prenatal Testing (NIPT): The Netherlands offers the Non-Invasive Prenatal Test (NIPT) for pregnant women but does not reveal the sex of the baby during the first trimester, adhering to a more conservative approach. In contrast, France offers early fetal sex determination if requested by the parents. In France, the NIPT test is also an option only if the combined test for trisomy asks for it.
• Pregnancy termination: In France, the terminology for pregnancy termination is distinct. Interruption Volontaire de Grossesse (IVG) refers to elective abortion, until 12 weeks , while Interruption Médicale de Grossesse (IMG) is used when pregnancy termination is medically necessary (not limited in time). In the Netherlands, elective abortion can be decided at any time before 22weeks.
• Monthly Appointments with Limited Testing: Pregnant women in the Netherlands typically have monthly check-ups. Unlike in France, there is less emphasis on testing for toxoplasmosis, urinary tests, and Group B Streptococcus, as these are considered less relevant in the Dutch context.
• Different Approach to Antenatal Classes: In France, antenatal classes are commonly led by midwives, providing education and support to expectant parents. All of this being reimbursed by social security. The Netherlands, however, relies more on expectant mothers taking an active role in educating themselves, with less formal preparation provided by other professionals (doulas).
• Role of Doulas: France has a growing trend of employing doulas to provide emotional and physical support during childbirth. In the Netherlands, the role of doula is different, as midwives take a more comprehensive approach to maternal care. On the other hand, they can be very needed because most of the women decide not to have the epidural during childbirth.
• Vitamin and Medication Supplementation: France often prescribes a variety of supplements and medications during pregnancy. The Dutch approach is more conservative, emphasizing a balanced diet and only providing supplements when deemed necessar (vitamine D, iron).
• Whooping cough Vaccination: Vaccination against whooping cough for pregnant women is a growing practice in France, but it is already running in the Netherlands.
• Gestational term differences: Pregnancies in the Netherlands have a due date at 40weeks. In France it would be 41weeks. Ultimately, this may not make a significant difference, as labor will not be induced before 41 to 41+5 in the absence of a medical indication..
• Specific cases: Breech Presentation: In France, a breech presentation often results in a External Cephalic Version (ECV) to turn the baby, pelvic X-ray to assess whether a vaginal delivery is possible or elective c-section. In the Netherlands, ECV is used to turn the baby, and pelvic X-rays are not routinely performed.

During and after childbirth

• Home births and birth centers: The Netherlands is renowned for its approach to home births (15%) and the availability of birth centers. This option is less common in France, where hospital births are more prevalent (99%).
• Low Epidural Use in the Netherlands: The Netherlands has a significantly lower rate of epidural use (20 % during hospital delivery) during childbirth compared to France (83%), reflecting the differing approaches to pain management in labor.
• Duration of Hospital Stay: Postpartum hospital stays differ greatly. In France, mothers may stay in the hospital for 3-5 days after a vaginal birth and up to 5 days after a cesarean section. In the Netherlands, hospital stays are typically only a few hours for vaginal births and 48 hours after a cesarean section.
• Kraamzorg Transition: The Netherlands’ postpartum care includes kraamzorg, where a maternity nurse provides support for the mother and baby during the first week postpartum. In contrast, France has a less structured approach to postpartum care.

While France tends to favor a highly medicalized approach, the Netherlands emphasizes natural and patient-centered care, aiming to preserve the normality of pregnancy and childbirth. Understanding these differences is essential for expectant mothers to make informed decisions about their care. Ultimately, both approaches have their strengths and weaknesses, and the choice between them should be based on individual preferences and medical needs.