Why countries should follow the Dutch example of maternity care

Mention the words “home” and “birth” together and it’s not uncommon to be on the receiving end of a lecture about how “dangerous” it is and about the potential for “complications”.  While the lecturers may be well intentioned, their opinions are usually based on misinformation, rumour and scare-mongering.  Hardly a month goes by without a new study released in the media, declaring a definitive answer to the question of whether home births are “safe”.

The problem is, what most studies fail to do is address the bigger picture – they are usually done in isolation, proving no global truth.  A study in the US concluding that there are more complications in home births than in hospital births does not inherently mean that a home birth anywhere in the world is more likely to end up with a complication – there are many other factors involved.  What’s worse is a focus on individual cases – unfortunately, babies do die during home births (and many of those that are reported are unattended births or “free births”), but they also die in hospital births.

In the Netherlands, the home birth rate is around 30% – the highest of any western country. The Dutch place a high importance on family and being “gezellig” which is an all-encompassing word for anything that is cosy, comfortable, familial, warm – a typically Dutch notion.  Which makes it unsurprising then that they would prefer a “gezellig” environment for labour and birth, in their cosy homes with familiar objects and faces nearby.

In addition to this, the Dutch believe that pregnancy and birth is a natural process that should be interfered with as little as possible; they believe in minimal intervention, non-medicalisation of low-risk pregnancies and natural pain relief in labour.  Not only does this encourage low-risk births, fewer complications, healthier babies and a faster recovery period for mothers, but it also results in a lower social cost – hospital births, and in particular Caesarean Sections, are a major public cost. Given that it is now widely accepted that higher intervention rates result in more emergency Caesarean Section births, it makes sense to encourage women to birth in a manner that is least likely to require medical intervention.

This can all seem alien and frightening to natives of France, the UK or US where pregnancy and birth are highly “medicalised” and often they are horrified when they are discouraged from, or don’t receive, what they see as standard practices such as Epidural pain relief.  However, those who learn about and go with the system, rather than fighting it, come to appreciate the reasoning behind these practices and are much more comfortable.

The Dutch midwifery system, like any other, has its detractors.  One of its biggest criticisms is the relatively high infant mortality rate (on par with Australia’s but high in comparison to other European countries).  However, a report released in 2009 (“Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births” [de Jonge, et al, Apr 2009]) concluded that “planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system”.  Other studies have further attributed the Dutch infant mortality rate to other cultural factors such as a higher average age of mothers, higher rate of smoking, and an increased infant mortality rate due to socio-economic differences in the large migrant population.

As concluded by de Jonge and company, there needs to be a complete system in place to support a high home birth rate without a raised risk level.  This is where the Dutch differ from other countries:

• The Dutch midwifery system is excellent – the midwives are highly trained and professional, and they work in close cooperation with obstetricians if the need arises.  Though they believe in minimal intervention, and testing, they are quick to refer cases to obstetricians to ensure the mother’s safety (the mother may or may not then be moved to shared care or solely to obstetrician care)
• In the larger towns and cities there are many hospitals and most women live within 30 minutes of one these hospitals
• The ambulance system is excellent and they are used to dealing with midwives
• Most midwives strongly recommend women do prenatal yoga classes in order to prepare their bodies for labour and birth (there are plenty of such classes in English)
• Women can decide right up until the last minute that they would prefer to be transferred to hospital – no booking necessary
• There is a unique and excellent after-birth care system with daily help from a professional carer (3-6 hours per day for up to a week after the birth) with things like feeding, bathing, changing, caring for the mother, light house duties, checking for any after-birth complications and recording baby progress

Other countries should study the Dutch system as a whole and use it as an example for their own, rather than dismissing the idea of home births when clearly there are many women (such as in Australia) who want the option.

Unfortunately, what is happening in the Netherlands now is an increased exposure to British and American television and media has caused Dutch mothers to demand pain relief, such as epidurals, which has led to higher rates of necessary medical intervention, and a slight drop in home births.

If you’re planning on moving to Holland, don’t be scared off by the stories, do some research and you may find yourself more comfortable giving birth there than in your home country. 

• When will women find their place?