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
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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
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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.
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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.
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EUROPEAN OBSTETRICS & GYNAECOLOGY SUPPLEMENT
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