Dear Annelies
Thankyou for your clear explanation of the maternity care system in the Netherlands.  I and many other midwives around the world envy you, and often quote your low rates of intervention, and your low rates of perinatal morbidity/mortality, and the safety of homebirth with skilled midwifery care and appropriate medical referrals.
I also wonder why breastfeeding is such a lost art in your country.  I have been told that many of the midwives, and the maternity nurses who come to the woman's house do not follow the "10 steps" type of breastfeeding management - prefer to settle the baby with formula so that the mother can "have a good rest".  Is this true?
Is it something to do with the political influence of the dairy industry in your country?  

Just wondering....
Joy Johnston
Midwife and lactation consultant in Melbourne, Australia
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www.webrider.net.au/~aitex/joy.htm


-----Original Message-----
From:   Annelies Bon [SMTP:[log in to unmask]]
Sent:   Saturday, May 30, 1998 9:55 PM
Subject:        Re: Home delivery/CNM/etc

Nancy Wight wrote:

"Although I haven't seen any research to support it, it is my impression that
CNMs do a better job, as a whole, at breastfeeding education, support and
practice, than most physicians.  We are getting far affield when we discuss
home births and morbidity and mortality statistics of deliveries by MDs vs
CNMs.  As a neonatologist who has had to "pick up the pieces" of unanticipated
problems during home deliveries,by both midwives and OBs, I would never have
considered it for my own delivery."

Here in The Netherlands we have a lot of homebirths. We do it as follows;

When a woman is pregnant she is labeled as having a normal risk pregnancy
(and expected delivery), or a higher risk pregnancy.  The women who are
labeled with higher risk, are controlled by a gyneacologist. They have a
hospital delivery usually attended by her gyn. The other women who are
labeled as having a normal risk are controlled by a certified midwifes and
the birth is attended by this midwife. The normal risk group are 'allowed'
to choose the place they want deliver: in the hospital or at home.  Half of
them chooses to have a homebirth. that's about 30-40% of all pregnant
women. During the pregnancy some women tranfer from the one group to the
other. Eg, when the baby is breech, the delivery have to happen in the
hospital (though these deliveries often are still attended by the midwfie).
OTOH there are women who transfer from the high risk group to the normal
risk group, and give birth with the help of the midwfie at home or in the
hospital).

so, we have 2 comparable groups of deliveries that can easliy be compared
in research: a group of normal risk deliveries that happen at home, and the
group of normal risk deliveries that happen in the hospital, both attended
by midwifes (who happen to be very good educated here!). All research show
that homebirths are (at least) as safe as hospital deliveries. There is a
small tendency to less interventions in homebirths. But this is a small
tendency, since the hospital births are as natural as possible too: we do
not have standard epidurals (most women deliver without any painkillers),
we have a low c-section rate (8%, still too high. It has raised the last 15
years, without any decrease in death rates of mother and baby). And the
perinatal mortality rate is one of the lowest in the world. Eg, it is lower
that in US.

The reason for this, is not only the birth system itself, but also a very
good prenatal care that makes that possible risks are detected early, and
very good postnatal care (every woman gets a maternity nurse over her house
for 8 days postpartum. This nurse controls mother and baby, and does the
household).

To come back on what Dr.Nancy writes: "I would never have considered it for
my own delivery."  I often hear that health professionals who work
themselves with deliveries (gyns and nurses), prefer to have a homebirth.

now the BIG question: WHY ARE OUR BF RATES SO LOW????????????
I think it has something to do with the 2 big formula producers we have:
Nutrcia en Friesland Nutrition. They are very present in hospitals and
practices of midwifes.

regards,

Annelies Bon  http://utopia.knoware.nl/users/abon/bfbronnen.html
mother of Dirk 7yo, Tom 5yo, Pieter 2yo (all born at home)
breastfeeding counsellor of the Dutch bf org "Borstvoeding Natuurlijk"
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