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Comment by SJSque | Hacker News Reader

Here in the Netherlands, they tend to kick the mother out of hospital as soon as feasible after the birth (typically after one night, or even on the same day), but as soon as you get home, the home nurse (kraamzorg, or "cradle care") arrives. She (and, as far as I know, it's always a she) will be at your home for something like eight hours a day for the first week or so after the birth, and will teach you how to care for the baby (even if it's your second, third, fourth, ...) and will monitor its health and progress. Remarkably, in the 'downtime' (e.g., when the baby is sleeping), she'll do household chores for you (such as clothes washing, vacuuming, washing up, etc.) and maybe even entertain any older children or go grocery shopping for you. The system works really well, and I've heard it be credited for the Netherlands' low infant mortality rate.

My family back in the U.K. can hardly believe it (especially the household-chores part); there, as I understand it, the mother tends to stay in hospital a big longer (typically for a few days), but once you're home, you're on your own...

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This is why my wife almost died in the US. We left the hospital after two days, and were left to fend for ourselves. We were so busy with the newborn that we didn't notice that my wife was developing an infection. By the time she fainted from a sudden high fever, it turned out she had a uterine infection. And after lying on a stretcher in the ER for 14 hours with not so much as a glass of water, she had a full-blown septicemia.

None of this would have happened with midwife visits at home (like we had in Germany for the second child). They check on the mother as well as the baby.

And you likely paid more overall for this "service" as well!

We paid as much as the Duchess of Cambridge, who also gave birth to her first child around that time!

NDaaS?

(Not Dying...)

Just to clarify that - having had a baby in the UK in the past 3 months - what you say isn't correct (at least for England and Wales; I can't comment on Scotland and NI but I very much doubt they have different systems).

Mothers are frequently discharged from hospital the same day, or the following day. My wife had some (relatively minor) complications and thus had a 2 day stay. This is longer than average. Even mothers who had C-sections (i.e. major abdominal surgery) seem to stay <= 3 days, unless there's bigger complications.

Once home, the mother's 'midwife' will make home visits 2-4 times in the first week before 'passing' the care onto a 'health visitor'. They will also visit at home (1-2 times a week) for the next few weeks, before this becomes an at-clinic care.

There's also 'infant feeding nurses' (i.e. breastfeeding support) as needed, although this one does vary per area.

So it's no-where near the Netherlands level of care (having someone do the chores those first few weeks would have been very useful!), but it is definitely not the case that "you're on your own" after leaving hospital after a multi-day stay.

That sounds almost identical to my (English) experience except I did it 25 years ago. In fact that's pretty much what happened when my baby brother was born 35 years ago.

Maybe worth noting that Scotland has had baby boxes for a while now:

https://www.mygov.scot/baby-box/

Discharged the same day?!

It's from 5 years ago, but I don't think much has changed since https://www.theguardian.com/lifeandstyle/2014/aug/29/new-mot... was published.

I should add that, from what I've heard, same day discharges is much more common for the second (/third/etc) child compared to having a first.

We wouldn't even have gone into hospital for the second one, except the midwife was unable (or too uncomfortable) to sew up the worse than expected tearing my wife suffered. Even after being whisked to hospital in an ambulance (at about 3 am), my wife was back home the same day.

Mostly, I believe, driven by the fear of infection.

First one was 48 hours, and we were unimpressed at them holding on to us for so long. Second was born at 02:10, we were home at 19:39. Both cases was after an induction.

Many babies are born at home.

Is it true in the U.S. that the baby doesn't sleep next to the mother in hospital? I've seen these warehouses full of babies on TV shows, like in this photo:

https://www.adoptionchoicesofkansas.com/wp-content/uploads/2...

But it always looks a bit distopian to me.

FWIW our California-born babies slept with us (and was never taken away from me, except to be cleaned and weighed, and I was right there next to them the whole time). The "room of cribs" was the neonatal intensive care unit. It was, thankfully, empty when we were there.

> It was, thankfully, empty when we were there.

uhmmm... Won't you rather wish they were not empty? I suppose it all depends on the manner of the emptying.

In a previous life I did tech support in a hospital. One day I was called down to the ER to fix a printer or some other routine thing. I was accustomed to the chaos of the ER but that day nothing was going on. I commented to a nurse that "it is dead in here". She promptly and firmly informed me that we don't say those kinds of things in the ER.

Baby making activity is not randomly distributed throughout the year.

Depending on where you live (i.e. when it is warm), the peak month changes.

https://visme.co/blog/most-common-birthday/

Every NOC (network operations center) I've ever been in, if you start to utter the phrase "sure is quiet today" or anything similar, someone tackles you to the ground before you finish it.

You don't tempt fate like that!

I would reason that if the neonatal care units are empty, it means that all the children recently born were healthy and didn't need intensive care. :)

Between the time our first (2011) and last (2017) were born, our hospital (Michigan, US) changed their policy to have the baby sleeping in the room rather than in the nursery. We weren't too thrilled with the change, to be honest—the time the baby was in the nursery allowed us to get some additional much-needed sleep.

> (I can't comment on Scotland and NI but I very much doubt they have different systems)

I can comment for Scotland: it's almost exactly the same. The territorial boards greatly prefer midwife-lead care, so the only times we saw a docter were: months before delivery, saw the GP once to confirm the pregnancy test results; a pediatrician a few hours after delivery to count fingers and toes. Everything else was midwives, and handing over to the health visitors 2 weeks after delivery.

Ah! midwifes. In Poland they are a dinging out species. Majority of them are in their 60s and... tired. Observing them washing the newborn is something to see: they use running water and hold the baby in one hand and operate faucet with the other. There's also a "patronage visit" when they strongly encourage the father to get his shit together and "just change the diaper, babies are hard to harm!". If you are lucky you may meet the midwife that helped your parents. Midwifes are also present during the birth. And they are in charge. Doctor is present. But has not much to say. He or she just has to follow midwifes directions, that's all. During my wife's first birth a doctor was over-voted and driven off by midwifes after suggesting Caesarian section. "I have 35 years of experience, do you want to deal with the next birth alone"?

> she'll do household chores for you (such as clothes washing, vacuuming, washing up, etc.) and maybe even entertain any older children or go grocery shopping

Our kraamzorg nurse even cooked us meals! She also taught us a lot of techniques on how to get the infant to sleep. My wife looks back very fondly to the first post-natal week and the kraamzorg was a big reason. Having someone nearby who's been there before is a big stress relief for first-time parents who are full of questions and concerns that first week.

From personal experience in the UK, you're kicked out of hospital after a few days during which you received amateur advice from nursing assistants and a final discharge check for the baby if the doctor is available (if not then you have to go back for the discharge check). Back home there are irregular visits from a nurse who usually writes random statements in the a red log book but aside from that you're on your own. If you have time for the internet you might learn about why a baby doesn't latch and then maybe find a private lactation nurse who may or may not give you useful advice. Maybe one of them has heard of tongue tie because the NHS doesn't believe in it (and they're not allowed to support anything but breast feeding...)

Not to disagree with your experience, but to clarify. Postnatal checks by the doctor may be performed up to 72 hours after birth [1]. The reason that the doctor might not be available, is because they may be attending a neonatal arrest call, which can require prolonged ventilatory assistance for the newborn by the doctor. In that setting, hospitals might want to make empty beds to enable more mothers to safely give birth in the hospital of their choice. In an ideal world, there would be more beds.

Finally, sorry to hear about your experience of tongue tie. This is also mentioned in link [1], so it's definitely not something that the 'NHS doesn't believe in'.

[1] https://www.nice.org.uk/guidance/cg37/chapter/1-Recommendati...

FWIW our experience was different. We left the hospital after 3 days, during which we received advice from professional midwives, including how to breast feed (and what to do if baby doesn't latch). At home visits from health worker and midwife were regular and data and notes in the red book did not at all seem random.

I would like to add my own anecdata that conflicts with this. We've had four children and our experience of ante-natal and post-natal care has been nothing like this for any of them.

The home visits are regular and scheduled, breatfeeding advice was offered in hospital, a breastfeeding support clinic is run for free in our local hospital once a week and on other days in local community centres. Two of our children have been identifed as tongue-tied by midwives in hospital. The midwives in hospital provided formula for the most recent baby when my wife was having trouble feeding.

Overall, we've felt very supported by the NHS. I suspect the difference is partly timing, every team contains good staff and bad staff. It probably differs region to region as well, I'm in Buckinghamshire.

Ours is a teaching hospitals trust, and a fairly large one I suppose, and we have had good experiences each time with our three children. I think there can be a big difference if you end up in a medical-led ward instead of a midwife-led one for the actual birth, but I expect there's lots of variance beyond that.

Sorry for your experience. We've actually had a decent interactions with breast-feeding support workers (and local groups). Our first had a tongue-tie which we had cut on the NHS, though it was very difficult to get them to give us any firm advice on it either way. It's sad if different trusts have such varied support.

I do agree that the health visitors probably end up being more hassle and causing more stress than they're worth. By the time of our third kid we just smiled, nodded and lied our way through every interaction until they went away.

> It's sad if different trusts have such varied support.

Different trusts in the NHS have wildly differing support, policies, physio, mobile apps, leaflets and documentation, etc etc. It makes the "N" in NHS a bit odd, and surely is tremendously inefficient!

(Having said that, and having recently had a baby the NHS and their staff have all been amazing!)

I had tongue tie until I was about 7 years old when my sister noticed something wasn't right. I was never breast fed so it didn't get picked up.

Fortunately for us, when having our first, we knew about it and in Southampton UK they are one of the better hospitals who check for it and can get it sorted at one of their breast feeding clinics.

Our kraamzorg experience is one of the reasons I will likely never return to the US from Holland. The amount of care that society here puts into practically solving problems, while maybe not sufficient for every societal ill, is incredible here.

> Here in the Netherlands, they tend to kick the mother out of hospital as soon as feasible after the birth (typically after one night, or even on the same day)[...]

For our two (both born in Amsterdam) we were out of the hospital 3-4 hours after birth in both cases (both induced, and with epidural). They do the bare minimal to make sure you're not actively bleeding (and stitching), measure the baby and then you're out.

When you get home the kraamzorg is there waiting for you. I think it's a much better system. You don't need hospital services (surgery, anesthesia etc.) anymore. Why would you want to stay in a hospital?

To add to the national comparisons - here in Japan the mother typically stays in hospital for a week to recover while getting help learning to feed, bathe and change the child. My daughter was born via C-section and so they kept my wife for 10 days. You can get a paid upgrade to a family room if you wish.

The tradition is then for the mother to stay at her parents house for a month to get help from grandma when she's learning the ropes (my wife lasted a week).

I couldn't imagine getting kicked out the same day. What a load of work! Especially if the father is expected to go straight back to work (as another comment said was typical before this year)

Paternity leave in the UK has been two weeks since at least my eldest was born, 15 years ago.

Ah sorry I was referring to the Netherlands

> credited for the Netherlands' low infant mortality rate

Wasn't Netherlands birth mortality rate actually higher when compared to neighbor countries because of the tradition of giving birth at home (which is not dangerous in itself but it means that valuable time is lost in the case the mother has to go to a hospital and the doctors there have to first sync up with the pre-natal nurse)?

Could be. I'm not an expert (I haven't even looked up the statistics), and I suspect that neither was the person who I heard crediting the kraamzorg system for the low infant mortality rate.

I certainly get the impression that giving birth at home is quite 'trendy' here, but my wife and I decided that there was no way that we were going to opt for that. My wife would much rather give birth in a building full of experts and specialised equipment than in the "relaxed, familiar atmosphere" of home.

Not really trendy, but more the way it has always been done. Childbirth isn't a disease and shouldn't be treated as such, is the rationale behind it.

Seems like a silly rationale to me. It’s not like evolution has optimized bodies to be amazing at childbirth. There are many possible complications that modern equipment and expertise can help with that aren’t available at home. You can do the same thing you do at home, with the security of having medical care immediately if things get complicated.

Despite all modern equipment and expertise „Intrapartum and neonatal mortality was 0.15% for planned home births, 0.18% for planned hospital births“ (source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5465453/). Something to think about.

Disclaimer: my wife gave birth at home (but not in Netherlands)

There is nothing to think about. Most serious cases would be treated in hospitals and, alas, sometimes there is nothing medics can do. If you want to think, think about, what those numbers would be if everyone was giving birth at home.

https://www.15min.lt/naujiena/aktualu/lietuva/vilniuje-ivyko...

What do you think about 60 baby birth deaths in hospitals this year alone in Lithuania? And it is shitty attitude to counter argument science with single really unhappy incident.

You can't just post a random paper and call the case closed. Some points from the paper:

- The populations studied were preselected to be low risk, because "Dutch guidelines prescribe a hospital delivery with their midwife-led delivery (no choice of planned home birth)" to women with medium risk levels. So we're not talking home vs. hospital for any women, just for those where the doctors say everything is double-plus super fine with the mother and the baby. The study did adjust for the fact that "either due to self-selection or due to the midwife’s proposal, the healthiest and most affluent women are more likely to undertake a home birth".

- From the conclusion, "the benefit of substantially fewer interventions in the planned home group seems to be counterbalanced by substantially increased mortality if intervention occurs".

Etc.

So what the study says is generally, if you and your doctors are double-plus sure you're low-risk, then you can go for either home or hospital birth; but if an intervention turns out to be needed, you're in big trouble.

I agree that case is not closed, however I was responding to very specific short sighted comment. About your points: Yes, you should understand if you or your relative is in low risk group. Honestly, if possible you should always understand and evaluate risks, whatever you are doing. Problem that humans are really bad with statistics (recommended reading "Thinking, Fast and Slow").

Lastly, you have actually read what I have posted and this is awesome. You can find more scientific sources about positive benefits of home birth. Lastly, I'm not saying that you should do it. My problem is that home births are semi-legal in my country ;-) Shortsighted comment was written by person from my country :-(

You have to keep in mind that there's quite extensive screening on eligibility and low barrier to refer to a hospital, as well as medical care will be available (experienced and well-trained midwifes are present during birth, GP will usually be on stand-by). If there is any major risk of complication, it will be a hospital birth. Living too far from a hospital? You better go there to give birth. Midwife and/or GP doesn't trust it anymore during birth? An ambulance is called and hospital it is (and you'll be there in time, as you live close enough). The distances in The Netherlands are extremely small compared to the USA, it's not like you're giving birth in the middle of nowhere.

A more recent trend is that of the 'geboortehuizen' (birth houses), which are literally what the name says: special places just for giving birth. Instead of the clinical atmosphere, it is more like a home but advanced medical care is close-by, as most of them are affiliated with the hospitals. It's seen as a good balance/compromise between the risks of giving birth at home, while still having a more quiet, 'gezellige' atmosphere.

For many many years (basically up to XX century) the most dangerous thing a woman could do health-wise was to get pregnant. Being pregnant is not a disease, but childbirth is a very high risk.

Less than 1% of stillbirth and possibility of mother's death is even lower. I'm pretty sure there are things that are more dangerous a woman can do.

"Stillbirth rates never exceed 70 per 1,000 total births." (source https://www.cairn-int.info/article-E_POPU_804_0683--late-fet...)

it's a disease as much as aging is a disease... extremely risky and often (always in case of aging) leathal.

Disagree. Aging is a disease as much as cancer is a disease - you'll eventually die of it if nothing else gets you before.

The difference between pregnancy and aging is that the former is desirable, the latter is something to get rid of.

It's correct that the infant mortality rate in The Netherlands is somewhat higher than neigbouring countries (the sixth highest of European countries), the cause of this is not exactly clear. There was a study in 2010 that drew much media attention, which reached the conclusion that you are talking about. However, the methodology drew some criticism, and followup research (e.g. this https://www.midwiferyjournal.com/article/S0266-6138(15)00214... from 2015) has contradicted the results.

Comparing home and hospital birth can be a difficult problem. Policy in The Netherlands dictates that women who are estimated to have a higher risk of complications must give birth at a hospital. This means that the hospital group's risk profile is inherently different, which is a factor that is difficult to compensate for. It also seems that lower educated women gain more safety from hospital birth, although the exact reasons are unclear.

Overall the question is not at all settled at the moment. The research community is also extremely hesitant to communicate with the media out of fear of causing another scare like what happened after the 2010 study. Fact is that home birth is becoming increasingly more rare, down 10 percentage points over the last 10 years.

Thanks for the link to the 2015 paper. I read the original paper around 2013 and didn't actively look for followup papers in the last years.

This 2004 paper examining the difference in infant mortality in The Netherlands[1] concludes that it's basically due to immigration, parents being older (father's age is also a factor), and fertility treatments.

Some ethnic groups in The Netherlands have 2x higher infant mortality after birth than others, people are older when they're having kids, and having twins (or more) is now 2x as common as in the 1950s due to the availability of fertility treatment.

I wonder how up-to-date the results of that older paper are, the other ones discussed here seem to address much narrower questions.

1. https://www.demographic-research.org/volumes/vol11/13/11-13....

Having a baby at home is silly given it has a higher mortality rate than in a hospital environment. I think after leaving the hospital have a helping hand is great as is before the birth with the pregnant mom's habits. However the most dangerous time is the actual birth and I would much rather have trained physicians around than a midwife.

> and, as far as I know, it's always a she

As I have learned a few months ago when our midwife came by daily the first 2 weeks after our baby was born (in Germany, healthcare insurance will pay for daily midwife visits the first 10 days after you are out of the hospital, and for additional 16 times in the first 6 weeks) there are exactly 4 male midwifes in Germany, which is roughly 0.017%.

I get it, however. Our midwife had 2 children of her own, and it is extremely comfortable to know that the midwife already went through all of that herself. There are some things that cannot be taught, and giving birth is definitely one of them.

> Here in the Netherlands, they tend to kick the mother out of hospital as soon as feasible after the birth (typically after one night, or even on the same day)

My wife stayed in the hospital for 4 nights (she was definitely not able to go home sooner) and it was a very pleasant experience. She basically stayed in her bed undisturbed with the baby and if she needed anything (including some time alone) the nurses where there. We were very pleasantly surprised as we both heard horror stories from our own parents who gave birth in the late 80ies (in Germany and Switzerland) when it was uncommon to put the baby in the same room as the mother. Apparently, breast feeding was often supervised in the hospital back then and the baby was weighted before and after to check the amount of milk it drank.

PS: We were extremely grateful that we had the midwife available 24/7 the first weeks. There is just so much going on, both with the child and the mother's body. We had many panic moments where we called our midwife, and she usually came by the same day or calmed us down via phone. However, I don't think a service like that is absolutely necessary if you have family support and if the child is healthy. As we later found out, almost everything we asked the midwife or were concerned about could've been answered by our own parents. In retrospect, we were absolutely clueless.

OTH the father had to until this year go back to work the next day...

True. In my haste, I neglected to mention that until recently the Netherlands has had one of stingiest paternity/partner leave policies in Europe. It used to be (roughly speaking) one or two days, as of this year it is one week, and next year it will become six weeks. Too late for me though! In my case, I saved up some of my holiday days to be able to take time off work (fortunately you tend to get a few months' warning before a baby appears in your life).

> fortunately you tend to get a few months' warning before a baby appears in your life

Yes but the baby can come anytime within a period of about a five weeks and be within the "normal" period. You need an understanding employer to take two weeks holiday "sometime in the next 5 weeks".

You do, and any employer who won't allow it is being an ass and should get ignored. Your family and your baby is more important than your manager's power trip.

Any responsible father takes two weeks off after the birth of a child. I'm glad it's mandatory now, but even before, it shouldn't have stopped any new father from spending those first two weeks with his family.

It's a very important period where you learn how to take care of the new baby, bond with it, and need to take care of your wife who quite likely is in no condition to do anything other than recover.

Not in the US, where paid leave for either parent is not guaranteed. Mom's are allowed 12 weeks unpaid leave, but only if her employer has 50+ employees. If she works for a small company, she's SOL. Dad's have no guarantee of anything. It's pretty horrific.

Just take the time off, then. What is this, slavery?

(I'm aware that people with very low incomes and no paid holidays at all, may not be able to afford that. But that situation should be illegal in any modern, wealthy country. I guess the answer to the question above may indeed be "yes" in some cases.)

Not American, but I believe taking unpaid leave is not necessarily an option there. Unless by taking unpaid leave you mean resigning.

What are you supposed to do when you are ill? What are you supposed to when a dependent is ill and in need of your care?

Never being able to take a day off for anything at all is incredibly harmful. People used to fight for these rights. What happened?

The US experiment with social democracy in the 1940s, which was not terribly comprehensive in the first place, has been slowly dismantled as the employer and political class continues to concentrate as much wealth and power for themselves as possible. Key to this has been to weaken and villainize labour unions at every opportunity.

When sick, you continue going to work until you wind up in the ER. If you're lucky, you don't get fired when you're there. Only exaggerating slightly. It's pretty sad.

As for what happened, the US isn't highly unionized outside certain regions and trades. Everybody else has next to zero legal protection. White collar workers typically get some leave simply by virtue of having skills that are more in-demand. And the labor movement largely allowed conservative, anti-labor factions to cast them as evil socialists. In the US, "liberal" has long been a bad word.

> People used to fight for these rights. What happened?

Everybody got convinced that a) those rights will be used by those people who obviously don't deserve it and b) those rights will make life harder for them when they become billionaire business owners.

Umm, sort of - without employment, one will likely lose any health insurance that one might have had and with that can follow financial ruin. "Lives of quiet desperation" is a fairly accurate description.

"Dad's have no guarantee of anything. It's pretty horrific."

This is not accurate. If the employer falls under FMLA, then dad gets 12 weeks unpaid leave as just like mom does.

In some states there is paid family leave for both mom and dad. I've used it twice.

My mistake. FMLA does extend unpaid leave to both parents. In my experience, fathers tend not to use it because somebody has to pay the rent. The father I do know who have taken leave did so because their employer offered paid leave as a perk.

Also correct that some states have additional leave requirements. 12 of the 50 have done nothing (only FMLA applies). 14 have lowered the FMLA business size from 50 to something smaller. 7 have adopted more generous maternal leave policies, though most only offer 50% pay over a short period of time.

Only 4 states offer paid paternity leave.

Regardless, the US is the only OECD member that does not require paid maternity leave.

> The system works really well, and I've heard it be credited for the Netherlands' low infant mortality rate.

Do not agree. Netherlands has remarkably poor statistics when accounting for total incidents and outcome from the months before and after births. They have more than double the shit rate compared to other high quality healthcare western European countries. Anecdotally I've heard this attributed to the custom of having close to 30%(?) of births done at home, which is an outlier and increases risks of poor outcome when complications arise.

But parent's notes on assistance post natal is probably correct and a very good thing.

This is so amazing!

Here in the US, when we had our twins, we knew that we would need a similar service - we hired a night nanny (note: just for nights, not daytime). Price was high, but our firstborn was difficult we knew we were out of our depth with upcoming twins (not to mention actually taking care of the older kid).

The night nanny did not monitor medical though.

Family is a great ideal, but often grandma doesn't remember how to take care the newborn, or help the mom.

For comparison purposes: in France, you stat 2-3 days after birth at the hospital, then a midwife visits you 1 to 3 times at home, complemented with “PMI”: nearby newborn centres where you can go for free to get tutoring, support, fever checkups, vaccines, etc. Also the mother gets some followup in the next 6 weeks.

You can get midwife care here in Canada, but it's something you sign up for, are not guaranteed to get, is more geared towards people seeking home or 'natural' births, varies in structure and quality from province to province, city to city, and like everything with our health care system is constantly under creeping threat from politicians of the right wing bent. In Ontario more funding was recently slashed, I believe.

That said we had the same midwife for both our children and she was amazing. Like family.

Didn't do chores for us though :-)

That's kind of heartwarming to read.

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