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Monday, 2 September 2013

Maternity care in the Netherlands: should other countries follow the Dutch example?

I have written about birth before- see for example here and here. I always think that I will never write about it again, but then I remember how important this is. This is why,  I chose to write about birth when I got to write an article for the Bill and Melinda Gates Foundation. It is such an honour, and it also allowed me to write in German (something I haven't done since I graduated from University). With their approval, I translated my post into English so that you can read it, too. You can find the original article in German on their blog, Impatient Optimists

In the Netherlands, homebirths and midwifery care are very common.  The Dutch maternity system is unique in all of the western world. Many books, articles and blogs claim that this system should be an example to follow for other countriesHow this system looks in reality? As a mom whose two of three children were born here, I want to share with you the pros and cons of the Dutch maternity system. 
“Pregnancy isn't an illness”
In the Netherlands, pregnant women are cared for by midwives who work in independent practices from 1 to 6 midwives. A midwife is the go-to person for women who learn that they're expacting a baby. If all goes well and there are no complications, the pregnant woman stays with the midwives till the end, and the midwife is present for the birth. In case of risk pregnancies  (such as twins, women over 35, women who have gestational diabetes and in case of abnormally big or small babies), a woman gets tranfered to a OBGYN.
At the beginning, check-ups take place every month, and at the end, even every week. At every check-up, blood pressure is measured. The midwives also check the growth of the baby by measuring the belly. Blood tests are ordered twice during pregnancy. A pregnant woman has the right to 2-3 ultrasounds. Internal examinations are rare.  Around 36 weeks, a woman can have a longer talk with the midwives concerning her wishes for the birth. Many decide to have their babies at home. 
The birth- natural and often at home
Statistics show that while 40% of pregnant women in the Netherlands wish to have a homebirth, only 22% actually have one. There rules for homebirths are very strict. At the first signs of problems, a woman gets transfered to the hospital. 
In the Netherlands, natural births are the norm. Even women with breech babies or twins are encouraged to have their children the natural way. Epidurals and other pain relief options are often dismissed as unecessary. If a woman wants to give birth in a hospital, first the midwife comes to her house to check on how the birth is progressing. Only then does she go to the hospital. 
After-birth care at home
After birth, the woman and her baby are sent home the same day. The so-called “kraamzorgster” comes to the family's house for several hourse for 8 days and takes care of mom and baby. She weights the baby, helps to get the baby to latch, shows the new mom how to change the diaper and bathe the baby. She also helps with house chores: cleans the bathrooms, can prepare simple meals (in my case she knew my favourite tea and made delicious fruit salads), and she sometimes can play with other children. At the beginning, it may be weird to have such a stranger in your home, but for the majority of women (including myself), she proves to be a great help. 
Midwives are powerful
Dutch midwives have a lot of power. If there is a GP who delivers babies, and a midwife in the same region, it is her who gets more money. It is also the midwife who gets to decide whether a woman can be treated by her or has to be transfered to a doctor (which could mean that they would be not willing to transfer even if they should). The midwives are getting even more competences. For example, they have recently been allowed to give labouring women gas and air as pain relief during labor and they can also prescribe some kinds of contraception (read about it here in Dutch).
Compared to other Western countries, the Dutch system offers many options to have the baby outside of the hospital, for example at home or in a birth centre. Additional servivces such as doulas or birth photographers are also getting more and more popular. Statistics like the Eurostat show that the Dutch perinatal mortality rate is comparable to other European countries.  However, other statistical data show that these rates are too high and they often blame the Dutch maternity system on top of the high number of high risk pregnancies. 
Furthermore, I miss having more choices: women who wish to have an elective C section, an epidural or a morphium shot for pain relief, or they just want to be cared for by an OBGYN, have to be very vocal about their wishes. Many expat women go to their own country for the birth for this very reason. 
However, the Dutch system is perfect for women who wish to have a homebirth or a natural birth in a hospital setting. 

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  1. So interesting, Olga! It is opposite here, in the States. Most births are attended by a physician. It is interesting to hear the maternal health differences in the Netherlands. And congrats on the Impatient Optimists piece!

    Jen :)

    1. Hi Jen, thanks for your comment. I've been reading about the situation in the US, and had a rather negative experience with the German system (which is more like the US system).. but I have come to realize that it depends on how the birth goes, how well do you feel supported by the system, and how well you are treated during pregnancy, labor and birth. In my opinion, there should be choices for women from all around, without compromising safety.

  2. Yes, they should. I have had 3 beautiful home births. Not a physician in sight. Most women don't need them. They are pains, really - and in most cases cause more problems than they solve. If they educated women correctly, you wouldn't see the outbreak we have of pre-eclampsia, pre term labor, etc. It's really sad, really.

    Love this post!

    Thanks for sharing!

    Actually, I'm pinning this to our Mommy Monday Pinterest Board and my natural birth board.

  3. Hi Lisa, thanks for your comment and I am glad you enjoyed this post. I wanted to have a homebirth with my second child and got risked out for meconium-stained waters, and for my third got risked out of a birth clinic for that very same reason. My third birth was the one I have the fondest memories of- and the only one I got pain relief for- and also had a doula to help me get it! The Netherlands is a perfect system for natural births, but midwives are well educated. And the kraamzorg is awesome! But midwives also often miss or ignore warning signs- just like everywhere, the Netherlands have pre-eclampsia, pre-term labor, and gestational diabetes. Except often the signs are missed or ignored because otherwise the midwife wouldn't get the money. I don't think this system would work everywhere- the Dutch are very hand-off in all things medical- more than I would consider safe. I feel that rather than installing some ideology on me, I'd rather have facts and make up my own mind, and have a system that supports it without compromising safety. In the end, I was very happy to have only one very hard birth (and let me tell you, if I had to go through this birth again, I'd be begging for a planned C section), and two light, easy births- including one with pain relief which I loved. However, yes, maybe overmedicating is an issue.. it is hard to find the balance!

  4. It was so interesting to read about Dutch maternity practices and to hear that the proportion of women who have home births is so high. What are things like when it comes to paternity leave entitlements in the Netherlands? I think I remember a dad blogger saying that they only got two days off, which certainly doesn't sound like a lot. It is, however, great to read about the extent of after birth care that is provided for the mother and baby.


    1. Hi Jonathan, thank you for stopping by and leaving a comment. I am not sure how many days fathers get, my husband got 10 days. However, mothers and fathers often choose to work half time and stay with the children more. The kraamzorg is so awesome and I will sing praise of it near and far- this part I'd actually love to see implemented everywhere.


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