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The Dutch midwifery system

The Dutch midwifery system is completely different to that in most other western countries. In those countries pregnancy and giving birth are seen less as a natural process and much more as possible threats to mother and child. In those countries pregnant women are given care by obstetricians. Midwives nearly always work in a hospital, under supervision of an obstetrician

Is pregnancy and birth a disease or a normal process?

In the Netherlands pregnancy and birth are considered to be normal processes that can be guided and supported in primary care, that is by midwives and family doctors active in midwifery. There is active cooperation between obstetricians and midwives, so that in the event of complications specialist care can be given in the hospital.

Specialists in hospitals are always prepared for possible complications. They see their clients primarily as patients. Experience shows that this often means they are more likely to intervene in the natural process of pregnancy and childbirth than a midwife would be. In countries where childbirth happens in hospitals, delivery is induced more often than in the Netherlands. The number of assisted deliveries (vacuum extractions and forceps delivery) in hospitals also increases. These kinds of interventions are an extra aggravation for mother and child.

Midwives are trained to prevent pregnancy and childbirth getting into the medical sphere unnecessarily. The same goes for clinical midwives. They don’t treat a woman who was referred to the hospital because of a complication (for instance meconium in the amniotic fluid) as a patient; they treat her and her pregnancy as normal. This is appropriate as the process of her delivery is in principle no different. There just has to be more supervision.

The advantages of the Dutch system are:

  • If there is no risk, women can choose where the wish to deliver their baby: at home or in a hospital
  • Pregnancy and delivery are treated as much as possible as normal occurrences
  • The more expensive secondary care is only used when necessary

In the Netherlands there is a choice of places where a woman can deliver her baby:

  • At home or in a birthing centre; this is possible if the pregnancy is normal.
  • In an outpatients’ department (a birthing room in a hospital). You can go home immediately after the delivery. This kind of delivery is usually supervised by a primary care midwife.
  • In the hospital. The woman will have to stay, on medical indication, for more than 24 hours in the hospital.

(source: KNOV)

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