Homebirth in the Netherlands

For further information, contact Melissa Maimann at Essential Birth Consulting. Link

... the largest study of ... home birth that has ever been done ... [showed that] the planned place of birth made no difference in the rates of babies dying or getting severely sick.

This is exciting and validating news for those of us who are advocates of home birth and midwifery care. ... the medical community is barking up the wrong tree: it’s not the location of the birth that is the problem ... it’s the fact that midwives are not integrated into the maternity care system. This causes problems with safe and timely transport.

What does the maternity care system look like in the Netherlands? Midwives are the primary care providers for all low-risk pregnant women and are fully integrated into the Dutch maternity care system. Midwives are independent, autonomous care providers and can attend births at home or in the hospital. Low-risk women are placed into “primary care” with midwives, and women who are at increased risk for complications are placed into “secondary care” with obstetricians; in other words, midwives are the routine provider for most pregnant women, and OBs are the specialists.

A woman might start out in primary care at the beginning of her pregnancy, and if risk factors arise during pregnancy, in labor, or during the postpartum period, she would be transferred into secondary care with an obstetrician. If the problem is resolved in secondary care, the woman goes back to primary care with a midwife. At the onset of labor, if a woman is in primary care, she can choose to give birth at home or in the hospital with her midwife ...

When a woman laboring at home has to be transported to the hospital, this can be accomplished quite quickly.

... Once they arrive at the hospital, the midwife may continue to care for the woman ... or she may be cared for by an obstetrician if the situation warrants secondary care.

How was “low-risk” defined in the study? * No VBACs at home * No multiples at home * No planned home breech deliveries * Hospital transport from home must occur after 4 hours of no progress in active first stage, and one hour of no progress in second stage

... How were women selected for the study? ... All women who were in midwifery-led care at the onset of labor were included in the study ... By definition, these women had low-risk pregnancies ...

... Of low-risk women in midwifery care, about 60% planned home births.

What does the data say? Of low-risk women cared for by Dutch midwives, the location of birth did not make any difference in outcomes for babies ... There were some characteristics of the women or their pregnancies that did seem to have an impact on the outcomes. Those having worse outcomes were the following:

* Primiparous * Gave birth at 37 weeks or 41 weeks * Were 35 years or older * “non-Dutch” ethnicity

... The Dutch study had a transport rate of about 30%; ... North American CPMs in 2000 had a 12% transport rate ... The hostility toward homebirth midwives is probably one big reason for this difference, and other facets may include more conservative indications for transport in the Netherlands, ease and readiness of the Dutch EMS transport system, and/or possibly different training of midwives.

... this new study contributes excellent data to the body of literature that continues to affirm that birth at home with qualified midwives is no more risky than birth in the hospital for low-risk women.

Melissa Maimann, Essential Birth Consulting 0400 418 448