Hi all,
The discussion lines we had the last days on health care staff behaviour, treatment refusal and home birthing, made me think of perceptions of safety and risc.
The world can be devided into two parts and a slice: developping world, were most babies are born ar home, because clinics are not reachable or not culturally desired; the industrialised world where babies are born in hospitals under drs guidance and a very high rate of unnatural deliveries and sectio's, and The Netherlands :-), where about two-thirds of births are planned to take place at home and one-third actually takes place at home. Neonatal morbidity and mortality rates, both maternal and infantile, in The Netherlands are not worse than in other industrialised countries. Why is homebirthing in many countries considered as high risk and do the results in The Netherlands contradict that perception?
I think at least two factors contribute.
First the attitude of drs and patients towards responsibility. If drs claim to be the one and only ones to know everything there is to know about every single bit of the human body and its functioning and if patients do agree to this (boldly stated, that is), then birthing will have to take place in hospitals under severe medical surveillance, guidance and control, because being something that has to do with the human body it has to be a medical situation. If, on the other hand, people see their bodies and it's functioning as their own responsibility and see themselves as their own experts, just seeking extra input in matters they really do not know about, then birthing is a natural process that will not need to take place in a medical setting.
Secondly, for homebirthing to be safe there has to be a well organised system to check for safety. In The Netherlands that starts with the education in sub-university level 4year midwifery school. Dutch midwifes work as independable HCP's and are trained, able to and allowed to do all prenatal controls, supervise uncomplicated deliveries, prescribe nutritional supplements and take blood samples, do epi's, give pain medication and stitch, and perform the postnatal controls, including the 6week pp check. Pregnant mom's start visiting the midwife around the 3rd month and see her(him) each month up to ab. week 34, then every other week and the last 3-4 weeks weekly. Midwifes screen every pregnant woman for riskfactors and refers to the gyn if needed. Gyn may take over or return the woman to the midwife if possible. Low risk pregnant women can choose to either deliver at home or in a short-stay hospital setting. Hospitals are prepared and fully willing to accept women in labour who turn out to need medical intervention during delivery. Midwifes can stay if desired. Postnatal care for up to 8 or 10 days at home (totalling ab 40 hours) by trained caregivers is the final security stadium. Midwifery care, home- and short-stay hospital birthing and pphomecare are covered by social security or private health insurance. Rent of the hospital deliveryroom is not reimbursed, though!
Sectio rates in The Netherlands are around 10% (and stable for years), natural delivery without painmedication or only some local perineum painkilling is prevalent. Birth preparing in different types of birthing classes (classic, Lamaze, haptonomic, yoga,...) is norm and often paid for (classic classes) by the organisation that provides the postnatal homecare.
Unfortunately, Dutch breastfeeding rates are not that glorious, although one would presume them to be. To achieve that, heath care providers need more focussed education.
Gonneke van Veldhuizen, IBCLC, Maaseik, Belgium
- one who gives birth is partly mother, one who nurses is fully mother
- Jacob Cats, 17th century
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