Trouble in homebirth paradise

It is axiomatic in homebirth circles that the Netherlands, the country with the highest rate of homebirth in the industrialized world, is a shining example of the safety and benefits of homebirth.

But it’s not and it hasn’t been for a number of years.

In the article Trouble in paradise, Hans Pols, senior lecturer in History and Philosophy of Science, University of Sydney, and a specialist in the study of Dutch birth practices, explains what happened:

It all started in 2003, when a major European study showed that perinatal mortality rates in the Netherlands were among the highest in Europe (10.5 per 1000 births …). After initial disbelief, denial … and criticism of the study’s methodology .., it was concluded that ‘the Netherlands has a problem’…

This startling realization prompted the government to sponsor a number of studies investigating the problem:

In the second quarter of 2010, the results of a large research project commissioned by the Ministry of Health were published. It concluded that the chances of an adverse outcome increase dramatically for women who were transferred to a hospital during delivery. In addition, the researchers noted that 25 per cent of risk factors had not been recognised by midwives, who are responsible for screening for them. Deficiencies in the organisation of care were thought to be responsible: in particular, the lack of communication, coordination and cooperation between midwives and obstetricians.


Later that year, a study [Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands: prospective cohort study] claimed that babies of women classified as low risk and starting care under the supervision of a midwife, had a higher rate of perinatal death and the same rate of admission to a neonatal intensive care unit when compared to babies of high risk women starting labour under the care of obstetricians. When a woman was transferred from home to the hospital during her delivery, perimortality rates increased almost fourfold…

Ironically, while American homebirth advocates have been (wrongly) touting the Netherlands as a homebirth paradise, Dutch women have reacted to the revelations that midwife care has a higher rate of perinatal death.

Giving birth at home appears to be falling out of favour in the Netherlands. The number of women opting for hospital births is increasing (from 70 per cent ten years ago to 75 per cent today), even though women classified as low-risk are required to pay additional fees…

And it is not just the issue of safety that is propelling them into hospitals:

The main reason is the extensive negative publicity related to homebirth and the availability of pain relief in hospitals. For a long time, both midwives and physicians discouraged pharmaceutical pain relief during labour. Dutch feminists have called for the right of women to pain relief, in particular epidurals, and questioned ‘the ideology of natural delivery and the positive meaning attached by midwives to women’s capacity to deal with pain without pharmacological support.’ Following a 2008 ministerial directive, women should receive pain relief on request …

Pols concludes:

… In the Netherlands, giving birth at home increasingly appears as an archaic procedure, once supported by an overly idealistic belief in the benign powers of nature. Although a great number of recommendations has been made and many plans developed, the amount of actual change thus far is disappointing. The Netherlands is the homebirth paradise no more and few international delegations will be visiting the Low Countries to see how delivery care is organised there.