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Monday, 13 May 2013

Can the Dutch health system make pregnant women feel guilty?



When I called the nice assistant at the birth centre I planned to give birth in and enquired about pain relief options, she gasped a little, and then uttered the m-word: “medicalized”. It sounded cold and distant and basically insinuated that a medicalized birth was the worst thing that could ever happen to me. When I went to my 6-weeks post partum appointment a while ago, the midwife felt sorry for me because I was not able to have my “dream” birth in the birth centre.

So I wasn’t, but I didn’t feel guilty, but why would I? Aaah, I see. Because the birth wasn’t “natural” enough. I totally get it that in many countries women feel that they don’t even have the chance for having a natural birth. I get it that women are made to feel guilty for even wanting a natural birth. In the Netherlands, midwife-led birth is the norm. I had friends who had homebirths (and I had planned one myself), I have friends who had successful VBAC’s (vaginal birth after caesarean). I have friend who had a natural, pain-relief-free birth with twins. All of these friends are very happy with their birth experiences. Good for them!

But I also have friends who were not satisfied with their experiences because they were refused pain relief. Friends who had to fight for their elective C sections with a breech baby because the midwives insisted on trying to deliver them naturally first, or friends who laboured for hours before they had the C section. I have heard stories of infections and defects missed or misdiagnosed. And, stories like mine- where people felt sorry for me because I was in the hospital, and making women feel guilty just because they chose to have pain relief.

I used to read homebirth stories from Birth Without Fear or similar websites. Then I discovered a great site called Happy With Hospital Birth with stories by women who gave birth in the hospital and were actually happy with their choices. Amy Tuteur of the Skeptical OB started a website called “Birth Without Guilt”, also collecting stories from women who were made to feel guilty about giving birth in the hospital, having an epidural, C section or induction, or then bottle-feeding their babies. I'm afraid that in the Netherlands, where natural births are the norm, many women would be made to feel guilty for similar reasons.

Who is to judge for women’s choices as to where and how their births are going to take place? I was happier with the hospital stuff, who took care of me and my baby than I was with my midwife, who dumped me for something that wasn’t my fault. The midwives also weren’t happy with my choice to have a doula. I then realised that for me, it is not the place of birth that is important, and not what happens during birth if mom and baby are healthy, physically and mentally.

When my doula asked me what was important to me during labour, I answered: “The right people”. The first time around, I had no one to support me, even though I was surrounded by people. The second time my husband was there but he was anxious and afraid, and also had to take care of Klara. The third time, the girls weren’t with us, and we had a great doula whose support was absolutely invaluable, and who also motivated me to get pain relief.

So, who’s to judge me for my birth when I was absolutely satisfied with my experience? I still have to smile when I think of Markian’s birth.

Maybe, instead of judging women for their birth options, maybe we should ask whether they were happy with the choices they made? and if they weren't, maybe we could ask what went wrong and support them better the next time? Instead of just assuming that all women want natural births, we should accept their choices no matter what they are?





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14 comments:

  1. I used an epidural. I thought my birth was great and that the hospital did an excellent job. Yes the nurses tried to encourage me not to use the epidural, but I do not see that as a bad thing. Overall the experience was excellent and I would not change a thing.

    I agree with your post though. Personally although they encouraged the natural birth thing, I was still given an epidural so that is what counts to me :0)

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  2. Hello, Mrs Ziller and thank youf or your comment! I am also glad that you got your epidural! I got a pethidine shot and that was great as well, and never had any problem. The hospital staff never judged me for my choices, but the midwives did. And that shouldn't happen because they really shouldn't push their philosophies on anyone! I am also gald to hear about positive experiences here, hope all women can get the birth they want!

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  3. This debate has been ongoing since I landed here 12 years ago and has my first child nearly 6 years ago. I knew I wanted a hospital birth and held out as long as possible for the epidural as I could. But I let my doctors know my preferences and luckily didn't have to fight too hard. When you get expats who know otherwise and have opinions differing from the locals, you're always going to have conflict. I like this article because you knew what you wanted and and you didn't let it interfere with the end result. I think too many women are swayed by the opinions of others, especially these guilt-inducing mid-wives; I stayed away from them because I felt they were not for me. I'm happy with my experience and sure would have loved an uncomplicated birth where the baby popped out with a cute push like in the movies after 5 minutes of labor, but like you said, the end result was what mattered. As long as both my baby and I were healthy, I personally didn't care about the means to get there. Thanks for your article and I hope more women stand up for what they want, rather than what everyone else thinks is right for them.

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    1. Hello and thank you for your comment! I am glad you had a great experience in the hospital. And good for you to be vocal enough to get what you wanted. But not all women are- should they be refused pain relief just because they didn't say they wanted one? And yes, while many women can be easily persuaded to have a certain type of birth, hearing stories by others actually helped me to hire a doula and become more vocal about my needs. I just wish we had more choices without having to be judged for them- especially if it's about our bodies and our babies!

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  4. Sorry to hear you had a bad experience with your midwife. I gave birth in Bronovo 3 years ago, and it was actually my midwife who suggested an epidural for me. I'm currently pregnant with our second child (34 weeks tomorrow), and am still undecided on whether I want to have a natural birth or not. Probably I will end up asking for an epidural, though, and hope that my midwife will be as understanding as was my midwife the last time.

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    1. Hello Sanula, congratulations on your pregnancy! The midwife wasn't so bad, she just did what she was told to do-in case of meconium, transfer the patient to the hospital, and that was a good move as she didn't take any risk. However, I couldn't feel but be punished because not only was I dealing with complication (which luckily was minor and he was fine!), but also with a totally new staff in the hospital. I was so lucky that they were nice and understanding! As for the epidural, I would ecourage you to write a birth plan. The midwives read it, and so did the hospital staff. If you don't want an epidural in the end, you don't have to ask for it. But if you do want one, it's there written down just in case, and they will be more inclined to give you one. I do hope all goes well with your birth! Good luck!

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  5. It's a bit like that here in Germany. I was warned before my first child that if I wanted an epidural, I would have to fight for it. I ended up having an epidural with both my children. The first one gave me the chance to have a sleep and try and recover a little 55 hour long birth and without it I wouldn't have been able to get my boy out. During my second labour I was determined to try and do it without an epidural but right near the end I demanded that they give me one and I tell you, if I ever go through labour again, next time I will not be holding off for 10 hours and pushing contractions to have it. This time round I felt what it is like to have pushing contractions and I never want to feel them again!!!

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    1. Hi, workingberlinmum! I gave birth in Germany the first time, and to tell the thruth I much prefer the Dutch system, but I think it was because I knew what was going on, and I don't have good memories of that birth, resulting in a bad case of the baby blues. I did it without the epidural then but I arrived at the hospital with 9cm dilation, and it was much too late, they didn't suggest anything else,though. But I thought the German system gave much more choice in this regard- in the Netherlands you have a midwife, not an OB (in Germany I had an OB but could have had a midwife as well or instead) But you're right. Some women prefer contractions, others prefer pushing. I prefer contractions, just like you.

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  6. I had one birth in The Netherlands (home) and in Australia (hospital). Both were very different experiences, but you're right, the most important thing is having good supportive people around you and feeling like you are making the choices that are right for you and your baby. Good on you for tackling this issue.

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    1. Hello Renee, thank you for your supportive comment- glad to have you here! You say your births were different- how? Were both positive experiences? Where would you go if you had to do it again? And I agree, choices are always good, and so are supporitve people during birth!

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  7. Hello European Mama,

    I'm a keen follower of your blog. I too am an expat here in Delft.
    I really like this article of yours and I totally believe in what you have said. We as women can't be judged. What works for one need not necessarily work for another. Especially as expats, we are used to something else from our countries. It's already quite difficult to adjust with the new system and I think they should be more supportive of our choices.
    I'm currently 30 weeks pregnant,and already dissatisfied with the system. I already have an existing thyroid issue, and the midwife conveniently said that there was nothing to worry! I can't imagine what could have happened, if only I had not visited my country in the beginning. Luckily my doctor there prescribed me the medicine, and finally after I came back here I had to nearly put up a fight to visit the specialist. They just don't seem to care which is really worrying.

    Thanks for giving a lot of information regarding parenting especially for bilingual education and other useful tips for expats! Keep em coming :)

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    1. Hello, Mrs Das! How nice of you to comment and to follow my blog! Congratulations on your pregnancy. I see how a thyroid condition can affect our health in general because my husband has also a thyroid condition- the midwives should take that into account! His condition is managed by our huisarts, maybe you could try visit a doctor? I don't think they don't care, it's just they have different expectations of what the system should and shouldn't do. But yes I also agree that they should be more supportive!

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    2. Thanks for your reply. Yea now I visit the specialist in the hospital after convincing them I needed it and wasn't just being a hypochondriac! Let's hope they are more supportive now on.

      Keep the lovely posts coming :)

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    3. How good for you! I believe in the Netherlands you need to be very vocal in expressing your needs, and if you're assertive enough, they are more inclined to listen! I also hope they will be more supportive! Good luck!

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