Midwifery in the Netherlands
The Netherlands has some of the most successful childbirth practices. As a result, the Dutch people have some of the lowest rates of infant as well as maternal mortality. The Dutch obstetrical model is so effective due to the country’s reliance on well trained midwives. The country has specific policies in place to minimize detrimental competition between obstetricians and midwives. In addition, the midwives are further supported by nursing assistants. With that said, midwifery in the Netherlands is still not perfect and there are some drawbacks. Midwifery practices in the country are drifting away from home birth and constantly becoming more technocratic.
In 2004 the Netherlands had an infant mortality rate of 4.4 per 1000 births. The United States in the same year had an infant mortality rate of 6.8 per 1000 births. In addition, the Dutch have a maternal mortality rate of 9.7 per 100,000 live births. This number is also significantly lower than the United States which has a rate of 26.4 per 100,000 live births.
One of the reasons that the Netherlands has such low rates of infant and maternal mortality stems from the country’s socialized medicine. However, this is not the only factor. The Dutch have a unique obstetrical model which heavily relies on midwives. Furthermore, Dutch midwives are supported through the utilization of home birthing assistants and government policies. As a result, the Netherlands has a birth system that is safer and less medicalized than other nations.
In the Netherlands midwives are highly regarded within society. Unlike, many other countries, the Netherlands only has one type of midwife. Furthermore, the Dutch government has recognized midwives as independent medical practitioners since 1865. As a result, of this acknowledgement, Dutch midwives must adhere to specific standards of education. They must attend one of four schools that specialize in midwifery. These programs last approximately four years. After this time, the student will earn a Bachelor’s degree in midwifery. Students also have the option to follow a midwifery Master’s Program. In order to be accepted to these programs students must have A level equivalents in chemistry, biology, and English language.
While at these midwifery schools, students are taught basic sciences. In addition, these programs emphasize the methods for successful deliveries during a birth without complications. But these schools have specific sections in which midwives are trained to handle abnormal births. Finally, most of the midwives in the Netherlands are private entrepreneurs. As a result, the Dutch midwifery school’s curriculum teaches their students how to be successful independent practitioners.
Dutch midwives additionally have an unusual amount of power. In most countries midwives are restricted in the actions that they are allowed to perform. But midwives in the Netherland are much less restricted. Dutch midwives can do blood work on their patients in order to give thorough diet advice. In addition, midwives in the Netherland are allowed to perform episiotomies under local anesthetics and to prescribe antithesis (D) immunoglobulin. In the United States only doctors are permitted to prescribe this medication. Moreover, the expansive power of Dutch midwives allows these medical professionals to more fully assist their patients.
Also, in the Netherlands there are policies in place to minimize the historical competition between doctors and midwives. In other places, this conflict has led to negative complications, such as the discrediting of midwives and the loss of many midwifery practices. But, in the Netherlands these groups appear to be in collaboration rather than competition. This collaboration stems directly from the Dutch’s insurance reimbursement process.
In the Netherlands births are divided into three risk categories: low-risk, medium-risk, and high-risk. These groups are determined on the bases of 124 symptoms. Insurance companies will only reimburse low-risk patients for the cost of seeing a midwife or a general practitioner. Individuals in the medium risk are advised to see an obstetrician for whom their insurance will pay. However, the patient giving birth is allowed to decide whether or not to have a midwife oversee their delivery. Lastly, high-risk births must be overseen by an obstetrician.
As a result, of having a distinct rubric which decides if a patient is seen by an obstetrician or midwife, there is not a lot of competition between these groups. Obstetrician and midwives are seen as two distinct medical professionals that serve completely different roles in the child birthing process. Furthermore, in births where obstetrician’s intervention is necessary, midwives are expected to stay with the patient. This stems from the idea that midwives serve a different role to the doctor. Therefore, it is seen as necessary for the midwife to stay and aid the doctor and the patient. As a whole, this collaborative doctor/midwife dynamic helps the patient since these medical professionals work together to care for patients.
The high number of midwives in the Netherland also aid the Dutch populous by reducing the C-section rate. Most developed nations have a much higher ratio of doctors to midwives than the Netherlands. For example, in 2002 only 8.1 percent of births in the United States were overseen by a midwife. On the other hand, 33.4 percent of births in the Netherland were delivered with a midwife. In the United States the high number of OBGYNs often leads to unnecessary interventions. OBGYNs can be sued if a death occurs in a situation in which the they did not take the most invasive action. Thus, OBGYNs often perform unwarranted cesarean sections in order to forestall legal action.
In the Netherlands, though, there is a much lower rate of Cesarean sections. Midwives do not perform this operation. Hence, this lower cesarean section rate likely stems from the higher percentage of midwives practicing. The percent of obstetricians has been on the rise in recent years and the C-section rate has nearly doubled from 7.5 percent in 1990 to 13.8 percent in 2004. But the C-section rate is still less than half that of the United States and within the range recommended by the World Health Organization. Overall, the Netherlands has an effective obstetric model with a relatively low C-section rate as a result of the higher percentage of midwives practicing
In the Netherlands midwives are also supported by a maternity home care assistant. The occupation of a midwife is extremely strenuous and time-consuming. People in this field of work may be called at any time of day to oversee a birth. In order to relieve some of the stress from midwives, the Dutch integrated in a maternity home care assistant. This maternity home care assistant takes care of the new mothers and their babies each day during a lying-in period. As a result of this assistant managing postnatal care, the burdensome workload of midwives is reduced.
If the maternity assistant notices anything unusual, they are advised to contact a midwife. Furthermore, the Dutch maternity home care assistant has a wide range of jobs related to monitoring health, such as checking the baby’s progress and temperature. In addition, the maternity assistants do house work, such as going grocery shopping and cleaning. This position of maternity home care assistant is vital for Dutch midwives because it significantly relieves their workload. Thus, Dutch midwives can focus all their attention on safe deliveries for mother and newborns.
The Netherlands is often portrayed as the utopia for midwives. An oft touted statistic is that 78 percent of women start their maternity care under the supervision of a primary care midwife. After hearing that 78 percent of individuals start their care with a midwife, people will likely assume that the majority of women give birth under the oversight of a midwife. However, this is far from true since only forty-four percent of women start labor in the company of a midwife. Moreover, only thirty-three percent of women deliver under the supervision of a midwife. However, these statistics do demonstrate the nature through which pregnant individuals are easily transferred from the care of a midwife to a obstetrician.
In addition, home births have steadily been decreasing in a linear progression over time. Thus, many home birth advocates are critiquing the Netherlands for drifting away from their midwifery practices that the country is known for. In order to prevent a further decline in home births, advocates are speaking out so to bring awareness to this issue.
The Netherlands drift from home births is not the only concern facing Dutch Midwifery. Many individuals directly seek out a midwife to help deliver their baby since that person wants a spiritual experience or a more “natural” birth. However, midwives in the Netherlands do not adhere to this model of midwifery. While Dutch midwives preach against invasive measures during childbirth, these midwives do not ascribe to notions of naturalism in childbirth.
In the Netherlands, midwives are up to date with the newest technological innovations. For example, numerous Dutch midwives have sonogram machines in their office. Many people find this adoption of technology to be problematic.
Historically, the integration of technology has led to unintended side effects. This is demonstrated through over utilization of specific medications in hospitals. For example, Pitocin is commonly given to women in labor so to increase the frequency and length of her contractions. However, these contractions can be too painful for the patient which leads to the use of an epidural. This epidural can in turn slow the rate of contractions. Thus, women may receive drugs, like Pitocin or Cervidil, to again increase her rate of labor. Cervidil can compromised blood oxygen flow to a baby which may lead to an emergency C-section. These medications are not necessary for giving birth and can result in negative consequences, such as an emergency C-section. This chain of events is often referred to as the cascade of interventions.
The Netherland has one of the lowest infant and maternal mortality rates. This in large part stems from midwifery in the country. Dutch midwives are able to perform so effectively due to the rigorous education process as well as their extensive authority. Furthermore, legislation surrounding insurance reimbursement creates a collaborative work environment between obstetricians and midwives. This legislation also causes more midwives to be practicing which results in lower cesarean section rates. The Dutch midwives are further allowed to succeed due to the maternity home care assistant relieving their workload.
Nevertheless, there are criticisms to be made of the the Dutch obstetrical model stemming from their decline in home births and adoption of technology. Even though, there are problems surrounding midwifery in the Netherlands, the country as a whole has a unique obstetrical model which many countries could benefit from observing.
