Science, Safety and Place of Birth – Lessons from the Netherlands


What Can We Learn from the Netherlands? Today, the Dutch perinatal research agenda is focused largely on lowering prenatal mortality and morbidity. The media portray home birth as dangerous and hospital birth as the only safe choice. The result is that Dutch women, like women elsewhere in the world, are made to believe that wanting a good pregnancy and birth experience is selfish and dangerous for their baby, and that wanting to give birth at home is the epitome of such selfishness. Faced with the artificial choice between a good experience and a healthy baby, women will, of course, invariably choose the latter.


In a recent editorial on the safety of home birth, The Lancet stated that “women have the right to choose where they want to give birth, but they do not have the right to put their baby’s life at risk”.25 Similarly, ethicists have argued that it is unethical for women to jeopardise the health of their children by choosing to give birth at home.26


unnecessary and potentially dangerous interventions linked with hospital birth. Given the cultural influence of the medical profession, it is unlikely that many women will choose to challenge its paternalistic warnings and insist on exercising their right to home birth, especially if they are made to feel that their choice might jeopardise their babies’ health.


However, women do not experience pregnancy and birth as mechanical events. They need autonomy and choice. They need care-givers who are not only technically skilled but also understand the power of empathy, listening and true care. If a woman feels that the care provider is capable, intuitive, understanding and flexible, she will have more confidence in herself and her experience of birth will be more positive.27,28


The biomedical and psychosocial models of


Interestingly, these admonitions – published in medical professional journals – rest on conclusions from the flawed studies mentioned above. There have been no editorials in the professional journals of midwives challenging women who choose the


1. Hendry C, The New Zealand maternity system: a midwifery renaissance, In: Davis-Floyd R, Barcaly L, Daviss BA, Tritten J (eds), Birth Models that Work, Berkeley: University of California Press, 2009;55–88.


2. Declercq E, De Vries RG, Viisainen K, et al., Where to give birth? Politics and the place of birth. In: De Vries RG, Wrede S, van Teijlingen E, Benoit C (eds), Birth by Design: Maternity Care in a Social and Cultural Perspective, New York: Routledge, 2001;7–27.


3. Davis-Floyd R, Barcaly, L, Daviss BA, Tritten J (eds), Birth Models that Work, Berkeley: University of California Press, 2009.


4. De Vries RG, Wiegers TA, Smulders B, van Teijlingen E, The Dutch obstetrical system: vanguard of the future in maternity care. In: Davis-Floyd R, Barcaly L, Daviss BA, Tritten J (eds), Birth Models that Work, Berkeley: University of California Press, 2009;38–41.


5. De Jonge A, Van der Goes BY, Ravelli AC, et al., Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births, BJOG, 2009;116:1177–84.


6. Birthplace in England Collaborative Group, Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study, BMJ, 2011;343:d7400.


7. MacDorman MF, Declercq E, Mathews TJ, United States home births increase 20 percent from 2004 to 2008, Birth, 2011;38(3):185–90.


8. Home birth rates, BirthChoiceUK. Available at: www.birthchoiceuk.com/BirthChoiceUKFrame.htm?http://ww w.birthchoiceuk.com/HomeBirthRates.htm (accessed 13 March 2012).


pregnancy and birth need to be reconciled and a balance between the male and the female research agendas needs to be found. Otherwise, women will lose control over their pregnancy and birth experience. The new perinatal research agenda in the Netherlands – a country long considered as an example of a woman-centered approach – may serve as a case study of this global problem. n


9. Evers ACC, Brouwers HAA, Hukkelhoven CWPM, et al., Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands: prospective cohort study, BMJ, 2010;341:c5639.


10. De Jonge A, Mol BW, Van der Goes B, et al., Dutch perinatal mortality. Too early to question effectiveness of Dutch system, BMJ, 2010;341:c7020


11. PAN Stichting Perinatale Audit Nederland, A Termesterfte 2010. Perinatale Audit: Eersteverkenningen [Mortality of “at term” babies, 2010. Perinatal audit: first explorations], Utrecht: PAN, 2011;34–35.


12. Janssen PA, Saxell L, Page LA, et al., Outcomes of planned home births with registered midwife versus planned hospital birth with midwife or physician, CMAJ, 2009;181:377–83.


13. Wax JR, Lucas FL, Lamont M, et al., Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis, Am J Obstet Gynecol, 2010;203:243.e1–8.


14. Klein M, Studying episiotomy: when beliefs conflict with science, J Fam Pract, 1995;41:483–9.


15. Michal CA, Janssen PA, Vedam S, et al., Planned home vs hospital birth: a meta-analysis gone wrong, Medscape Today, 04 January 2011. Available at:


www.medscape.com/viewarticle/739987 (accessed 09 February 2012).


16. Hayden EC, Home-birth study investigated, Nature, 18 March 2011. Available at:


www.nature.com/news/2011/110318/full/news.2011.162.html (accessed 13 March 2012).


17. Keller EF, Reflections on Gender and Science, New Haven, CT: Yale University Press, 1996.


18. Harding S, Sciences from Below: Feminisms, Postcolonialities, and Modernities, Durham, NC: Duke University Press, 2008.


19. De Vries RG, Nieuwenhuijze M, Van Crimpen R, et al., The necessity and challenges of International Midwifery Science, Int J Childbirth, 2011;1(1):61–4.


20. Effting M, Babysterftehoog door falend system [Baby deaths high because of failing system], Volkskrant, 3 November 2010.


21. De Vries RG, A Pleasing Birth: Midwifery and Maternity Care in the Netherlands, Philadephia: Temple University Press, 2004.


22. Van Teijlingen E, A Social or Medical Model of Childbirth? PhD thesis, University of Aberdeen, 1994.


23. Buitendijk S, Zeitlin J, Cuttini M, et al., Indicators of fetal and infant health outcomes, Eur J Obstet Gynecol Reprod Biol, 2007;111(Suppl. 1):S66–77.


24. EURO-PERISTAT Project, European Perinatal Health Report, Available at: www.europeristat.com (accessed 29 March 2012).


25. Home birth–proceed with caution, Lancet, 2010;376:303. 26. Chervenak FA, McCullough LB, Arabin B, Obstetric ethics: an essential dimension of planned home birth, Obstet Gynecol, 2011;117:1183–7.


27. Larkin P, Carroll M, Begley CM, Devane D, Women’s experiences of labour and birth: an evolutionary concept analysis, Midwifery, 2009;25:49–59.


28. MacKinnon K, Mcintyre M, Quance M, The meaning of the nurse’s presence during childbirth, J Obstet Gynecol Neonatal Nurs, 2003;43:28–36.


29. CBS Statline, Centraal Bureau voor de Statistiek, 2012. Available at:


http://statline.cbs.nl/StatWeb/publication/?VW=T&DM=SLNL& PA=37302&D1=0-2,23-44&D2=a&HD=120104- 2121&HDR=T&STB=G1 (accessed 13 March 2012).


EUROPEAN OBSTETRICS & GYNAECOLOGY SUPPLEMENT


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