Postpartum care in Europe: Which countries provide at-home help for mother and baby?

Irene is a 30-year-old Spaniard from Madrid who has lived in Amsterdam for some time. After giving birth to her first daughter, she was accompanied home from the hospital by a kraamzorg. This is a qualified nurse who makes frequent home visits during the first eight to ten days following childbirth.

Healthcare in the Netherlands is a universal, private, and mandatory system. All residents are required by law to have basic private health insurance (basisverzekering).

“I found out about kraamzorg when I was pregnant”, recounts Irene in a conversation with El Confidencial. “You have to apply for it yourself, and it’s arranged through agencies. Since I have the most basic insurance plan, I had to pay about €170 in total for this service, and my insurance covered the rest. They help you check the nappies for poop, take the baby’s temperature, give the baby a bath, and assist with breastfeeding. For me, being a first-time mum with my parents not on hand, it helped a lot.”

She admits that at first it was “a little weird” to have a stranger in the house. “It feels a bit intrusive until you build up some trust, but in the end, you just want them to give you that help so you can get some rest.”

Irene recalls how, at night, the kraamzorg would take care of the soiled nappies, noting the times the baby had a bowel movement and the amounts she was fed. “When the kraamzorg arrived in the mornings, she would write everything down in her notebook and ask me how the night had gone and if I wanted breakfast. She’d check my stitches, my temperature, and my blood pressure. Plus, if I needed to sleep, she would stay with the baby and wake me up if it was time to feed her.”

Irene was pleasantly surprised to receive help with household chores, like laundry and bathroom cleaning. “You’re 100% focused on the baby, and there are things – like meals – that become secondary. The kraamzorg takes the time to check on you and make sure you’re okay. Beyond teaching me how to be a mother, she helped me feel more confident and at ease."

This service is not unique to the Netherlands. In Hungary, there are visiting nurses (védőnő in Hungarian), who are specialists in maternal and pediatric care. Folk Florina, 66, has spent her career in this vocation. “We are professionals who have graduated from a college or university, and we monitor and support families from pregnancy through the end of compulsory schooling”, she tells El Confidencial. “Our care focuses on the baby’s physical and mental development, proper nutrition, screenings, and vaccinations." 

For Florina, emotional support is what a mother needs most after giving birth. “The environment is very important. She needs someone to listen, as well as encouragement and positive reinforcement.” In her 30-plus years of experience, Florina has seen how motherhood has changed. “The barrage of information in the world has altered the attitudes, preparation, and questions of expectant mothers. In light of this change, we visiting nurses have also had to supplement our professional training to keep up with the times and, of course, our digital skills. We’ve also had to learn about and accept new educational responsibilities and understand the different types of family structures."

Florina has practised in the same district for the past 33 years and has followed the births and lives of more than 1,000 children. She still remembers the first family she cared for, and has never forgotten those who lost their child. “The hardest part is the loss of a child or to battle incurable diseases.”

Parental care elsewhere in Europe

In Spain, prenatal care is primarily provided by midwives, who are nurses specializing in obstetrics and gynecology. After childbirth, the pediatrician is the doctor responsible for the baby’s health throughout all stages of development.

Ana Isabel Anocibar Marcano, a primary-care midwife and board member of the Spanish Association of Midwives, lists the “interesting” features of the kraamzorg model. “It places care within the natural environment of the mother and the newborn. It allows for comprehensive care during a vulnerable period, allows for early detection of problems, provides advice on breastfeeding, and helps the family to adapt to the new situation. It provides continuity of care and very close support.”

This midwife emphasizes the “high quality” of Spain's postpartum care, but notes that the situation varies greatly depending on the region and available resources.

France does not have a direct equivalent to the kraamzorg model, but it does offer several postnatal follow-up programmes. The closest such is Prado Maternité, managed by the state healthcare provider, Assurance Maladie. This service entails home visits by an independent midwife following hospital discharge and provides follow-up care until the baby’s twelfth day of life. The focus is on the mother’s recovery, the newborn’s health, nutrition, breastfeeding, and family adjustment.

In addition, the Protection Maternelle et Infantile is a public service that offers consultations and home visits by midwives or pediatric nurses, particularly to disadvantaged families. But its coverage varies by region, so it does not constitute a standardized national system of home support.

Since July 2022, France has also mandated a postnatal check-up between the fourth and eighth weeks after childbirth. The goal here is to screen for postpartum depression and identify any specific support needs.

Austria also lacks a direct equivalent to the kraamzorg model. Its postnatal care system includes home visits by midwives, but not comprehensive practical assistance with daily life. The visits are mainly geared toward the medical and mental-health needs of the mother and the newborn: monitoring uterine recovery, providing breastfeeding support, and tracking the baby’s development.

Lisa Rakos, president of the Austrian Midwives Association, says that if these jobs are done thoroughly, they take "about an hour”. Many midwives see five or six families in a single day, leaving little time to assist the mother with other daily needs. Rakos sees this practical support as a major advantage of the Dutch model, allowing new mothers to enjoy nutritious meals and a tidy home, or simply to have someone to talk to or to look after the baby while they take a shower. There are no concrete plans in Austria to implement such a system.

Lisa Rakos calls for greater involvement of midwives during pregnancy, with at least one mandatory and free consultation at the beginning of the pregnancy. In her view, this would allow for earlier detection of physical or psychological stress, as well as loneliness, poverty, language barriers, and domestic violence. It might provide women with more options in a system where routine prenatal checkups remain almost exclusively the domain of obstetricians and gynecologists.

Finally, Czechia offers no state-subsidized postpartum visits at all. The law only requires parents to register the child with a pediatrician shortly after birth. During this first visit, the doctor will perform the required examination and provide basic advice to the primary caregiver. Everything else is up to the parents.

👉 Original article on El Confidencial

🤝 This article was produced as part of the PULSE collaborative project. György Folk (HVG, Hungary), Gian Paolo Accardo (Voxeurop, France), Magdalena Pötsch (Der Standard, Austria) and Petr Jedlička (Denik Referendum, Czech Republic) have contributed to it.