Saturday, July 13, 2013

Childbirth and Infant Mortality Abroad: The Netherlands

By: Marley Phillips, ANM Intern

Okay folks, let’s talk about the Netherlands. The Netherlands has the 20th lowest infant mortality rate in the world. Not as impressive as the other countries featured, but I digress. This country has had worldwide recognition for its maternal healthcare, and I wanted to know why. The Netherlands is home to possible the most risqué city in the world, Amsterdam. The country as a whole is known for its sexual promiscuity and frequent visits to the “coffee shop”. With this knowledge, I did not expect the Netherlands to be a very family-friendly place. However, the government strives to take care of expectant mothers and ensure parents and babies are happy and healthy.

The Netherlands requires all citizens to buy approved private insurance plans. Insurance must cover anyone who asks for insurance. Citizens pay flat-rate premiums for all ages and incomes. If people use less than a preset amount of care in a given year, they get a refund. All insurances cover birth, but all insurances may not cover a hospital birth. Insurance also covers the cost of a kraamzorg service, but more about that later.

Holland is known for having the highest rates of homebirth in Europe for decades. We’ve always heard the amazing fairytales of a magical place where women get to choose where they birth. And midwives; oh, midwives for miles and miles! Despite the stories, the Netherlands’ home birth rates have been steadily declining for quite some time, and are now at an all time low of 24%.  Now, 24% may not seem very low to you or I here in America where the home birth rate is less than one percent and absolutely, completely taboo. But, for Holland, this is a staggering drop in numbers. 25 years ago, over 2/3 of women gave birth at home and now less than 1/3 are opting for the same birth experience. So why are so many women running for the hospital these days? According to this news story, some doctors are saying women now want a variety or pain relief and speedy deliveries. Seems like Holland is catching up to the rest of the world’s need for luxury and promptness.

After confirming the pregnancy with a general doctor, doctors can refer a midwife or women can choose their own midwife. The first appointment with a midwife won’t be until around week 12, where the midwife obtains medical history and does screening to assess if a woman would qualify for home birth, or if she should be referred to an obstetrician. The midwife will continue to monitor a patient’s condition to ensure she is the perfect candidate for home birth.

In the first 12 weeks of pregnancy, women should also arrange for a kraamzorg service. What’s a kraamzorg service, you ask? A kraamzorg is a wonderful service offered to new families that provides in-home postnatal care. Along with showing the new parents how to bathe and dress and basic breastfeeding support, the kraamzorg will also do some light cooking and cleaning around the house. The kraamzorg stays for about a week for 4-8 hours per day, depending on the need. Since this is such an amazing service, women are encouraged to find a kraamzorg service by the12th week of pregnancy because it could be difficult to find an availability.

If a woman opts for homebirth, there’s not much procedure. Labor starts, midwife comes, out pops baby. The only thing is that each bed will require a metal riser to meet safety regulations for delivering a baby. Obviously, there is no type of pain medication when giving birth at home, so if a woman wants that she needs to go to a hospital. Although, I should mention only about 10% of women actually get the pain medication in Holland, and doctors are not too willing to administer it. When pain relief is given, it is usually in the form of an opiate-based liquid on a push-button basis. A midwife will deliver the baby, unless there is some type of abnormality, and most women are released within 24 hours of delivery.

Another option for expectant mothers in the Netherlands is a maternity hotel, or kraamzorghotels. These hotels offer a home birth for women whose home can’t accommodate a birth, or who simply don’t want to stay home. In these hotels, the woman and her husband (or other guest) can stay in luxury and she delivers her baby, and will have a kraamzorg immediately available to help when the baby arrives. Prices weren’t available, but some insurance will cover this. There are also maternity clinics for these women who can’t have or don’t want a home birth. Women may choose this option as a way to be close to hospital amenities in case of emergency, but not actually have to birth in the hospital.

Breastfeeding is heavily encouraged in the Netherlands, although the numbers may not necessarily reflect that. 80% of women initially begin breastfeeding and by 6 months that rate has dropped to 20%. Many women attribute this to feeling unwelcome while feeding in public, as well as returning to work, even though the Dutch have great legislation for breastfeeding moms. The Netherlands has also started putting in breastfeeding cafes around the country. These cafes serve as a place for mothers to meet up and nurse, share stories, give advice, etc. The country is also working on setting up public destinations specifically for nursing moms, so that they may not feel shunned or be asked to leave any establishment while feeding, which has been a hot button issue in recent years.

So, here’s the Netherlands: nothing overly spectacular or groundbreaking happening here. Midwives handle nearly all the deliveries, whether at home or in the hospital, and there is a harmonious system between midwife and obstetrician that is clearly working for this country. Holland maintains a fairly hands-off approach to pregnancy and childbirth, and I am really hoping this country doesn’t follow in the footsteps of the rest of the industrialized world and begin over-medicalizing the natural art of childbirth. Yet, based on these new statistics, the  Netherlands reputation as home birth capital of the world may be quickly fading.

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