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The nation of Holland consistently has among the finest statistics for mother and baby health in the world. Holland is a model for us to follow.

Contrary to popular misconception, Holland has a widely diverse population, with as many as 23 languages spoken at prenatal clinics. Many immigrants to Holland come from societies where women have little education, economic power or freedom of choice. These women would be at higher risk for developing complications in birth. Yet Holland has consistently fine statistics in maternity care, and mother-infant and child-family health.

Like several other Northern European countries, Holland has a national policy that guarantees every woman a midwife from the beginning of pregnancy through the first year after birth. In Holland 30-40% of births still take place in the home under the care of a midwife. This is because home birth with skilled midwives has been proven to be safe and cost-effective in the long run. Obstetricians and hospitals are reserved for women and babies at risk for developing complications in birth.

Access to health care

A second important feature is that a community-based team of primary care practitioners has the responsibility of seeing that every child and family have the healthcare and social services they need to maintain good health. This team consists of a family physician and includes a midwife and social worker. Any one of them can initiate hospitalization or call a specialist physician such as an obstetrician or neonatologist when a baby's condition necessitates that response.

When the home birth rate dropped to 30% in the 1970's because more and more women began seeking obstetricians (a direct result of the impact of American obstetric practices infiltrating world health), the government recognized it as a dangerous and costly trend. A multi-disciplinary commission was formed to evaluate maternity care and make recommendations.

Balance of power

The national health policy of Holland had always recognized the importance of maintaining a balance of power between family physicians, sub-specialist physicians, and midwives, with each profession needing to be independent in order for the team to work.

Before the commission, family physicians had slowly been phased out of attending home births in favor of midwives, leaving a power imbalance toward hospital based physicians (OB's, natalogists, peri and neo). Midwives, who earned less money than obstetricians and were beginning to have less prestige with the public, needed special support. Otherwise, the government recognized, obstetricians and perinatologists would soon take over, resulting in a loss of normal birth and the runaway costs associated with routine hospitalization for birth and unnecessary procedures and interventions.

Current policy in Holland assures that any woman who has a complicated pregnancy or birth has guaranteed care by physicians in a hospital. Because every Dutch adult is required to have some form of health insurance there is no direct cost to a family when a woman or baby needs a physician or hospital care.

Midwife as gatekeeper

Any woman has the option of choosing to be cared for by an obstetrician and birth in a hospital. However, if she has no medical indication for her choice, then she is responsible for paying for the privilege. In addition, every midwife has guaranteed hospital privileges. Because the midwife is the gatekeeper (for maternity care in the neighborhood), she is responsible for all physician referrals, and helps insure that physicians do not abuse either technology or their patients, by doing unnecessary procedures.

This has kept Holland's cesarean rate well below 10%, despite the eagerness of obstetricians to perform more cesareans. Holland's maternal and infant health statistics constantly rank among the highest in the world. Note: For decades Holland's cesarean rate was below 4%; increasing pressure to "modernize" has brought rising rates of intervention.

Postpartum care

A third important component of Dutch maternal—infant care—is that every mother is offered postpartum doula care at minimal cost. From two to eight hours a day (depending on the family's need or the woman's preference) a doula comes to the house, and cares for the mother, helps with breastfeeding, does house keeping, runs errands, and cares for siblings. Doulas in Holland have special training as a profession, keep records on the family's health, report to the midwife, and play a crucial role in maintaining high quality care, with the support of government subsidy. This is because they have been found cost effective.

Contrary to what U.S. medical organizations lead us to believe, Holland has shown that it is possible to identify those women at risk for developing complications during labor and predict the vast majority of serious problems with a high degree of accuracy. Only 20-30% of all birthing women fall into this category, and most of them do not develop any complication. The remaining 70-80% can safely birth at home or in a birth center.

Effective system

A midwifery-based maternity child health care system does not train more specialist physicians and than is needed. It utilizes them and hospitals as important adjunct service for those mothers and babies who are likely to benefit from medical treatment. In such a system midwives, obstetricians and neonatal pediatricians are colleagues who respect and support each other.

Holland, along with Denmark, Sweden, and Britain, supports at least 9 months of breastfeeding in addition to a complete system of paid maternity leave. Mothers who work are allowed time off to breastfeed their baby during the day. Despite the initial cost of such a complete well-integrated maternal-child-family system, Holland has proven the long term benefits of such a policy. This is probably the best model today for us to look towards.

My thoughts to follow.
valancystirling: (Default)
Probably most important study:
Outcomes of planned home births with certified professional midwives: large prospective study in North America
Kenneth C Johnson, senior epidemiologist, Betty-Anne Daviss, project manager
BMJ 2005;330:1416 (18 June), doi:10.1136/bmj.330.7505.1416

Article about paper--Outcomes of planned home births...

Journal Abstracts, homebirth, waterbirth, safety, risks of high-tech interventions

Journal of Nurse-Midwifery articles FOR PURCHASE
The cost-effectiveness of home birth
Journal of Nurse-Midwifery, Volume 44, Issue 1, 2 January 1999, Pages 30-35
Rondi E. Anderson and David A. Anderson
Piercing the veil: The marginalization of midwives in the United States
Social Science & Medicine, Volume 65, Issue 3, August 2007, Pages 610-621
Steffie Goodman

The History of Midwifery and Childbirth in America: A Time Line
Prepared by Adrian E. Feldhusen, Traditional Midwife
© 2000 Midwifery Today, Inc. All rights reserved.

History of midwives--centered on Nurse Midwives

Frequently Asked Questions about Midwives

Citizens for Midwifery Resource page

Safety: How Homebirth Measures Up

Homebirth Safety/Advocacy
including these topics:
Parents Share Information About Homebirth
Hospital-Acquired Infections and Resistant Bacteria
Birth Trauma
Midwifery Advocacy and Statistics
Anti-Intervention Philosophy
First Time Mothers
Subsections on this page:
Homebirth Safety Equivalent to Many Mainstream Choices
Homebirth Safety References - North American Prospective Study, 2005
Homebirth Safety References - Pang Study, Washington State, 2002
Homebirth Safety References - Australian Outback Study, 1998
Homebirth Safety References - British Suite of Studies, 1996
Homebirth Safety References - Other Studies
Homebirth Safety References - General
Homebirth Safety - Equipment Only Part of the Picture
Homebirth Safety - Dangers of Hospitals
Why Is Homebirth Safer?
Emergency Cesarean As Accessible for Homebirth As In Hospital
Homebirth Special Circumstances - First-Time Moms, VBACs, Large/Heavy Women, Smokers
Talking to the Press
Cost Effectiveness of Homebirth
Other Benefits of Homebirth
Homebirth Advocacy
Homebirth Outside the U.S.
Excellent blog following homebirth/midwifery news

Homebirth in the UK
by Brighton Homebirth Support Group © 2002 Midwifery Today

The Safety of Home Birth
by James Hughes, Ph.D.

Fish can't see water: The need to humanize birth in Australia
article by Marsden Wagner (MD, MSPH)

Nurse-Midwifery: The Beneficial Alternative
Article: Public Health Reports *September/October 1997 Volume 112
Mary Gabay, MS and Sidney M. Wolfe, MD

Attitudes- of obstetricians and midwives: a neglected area of study?
Journal of the Royal Society ofMedicine Volume 78 August 1985

The Economics of Birth in America

Holland's Model for Childbirth

Midwives Alliance of North America, homebirth reference

On choosing a supportive birth place, cites references.

Economic implications of method of delivery.
American Journal of Obstetrics and Gynecology, Volume 193, Issue 1, Pages 192-197
V. Allen, C. O'Connell, S. Farrell, T. Baskett

Women Who Give Birth During Hospitals' 'Peak' Hours More Likely to Undergo Obstetric Intervention, Study Says
[Jul 22, 2002]

Birth Myths/Facts

The Assault on Normal Birth: The OB Disinformation Campaign
by Henci Goer ©2002 Midwifery Today, Inc.

Obstetricians Use Dubious Method In Attempt to Discredit Homebirth
Motives Questioned by Parents, Midwives, and Public Health Researchers
Feb. 11, 2003

Refuting the Pang study


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