No pain, no gain? Giving birth Dutch-style

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Emma Thomasson is chief correspondent for Reuters in the Netherlands. Since joining Reuters in 1995, she has worked in Bonn, Cape Town, Johannesburg and Berlin. She has been based in Amsterdam since 2004. In the following story she writes about giving birth in a country where childbirth is seen as a natural process that should not be medicalised unless there are complications.

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... When I discovered I was expecting a baby during my posting to the Netherlands, I spent much of my pregnancy trying to work out how to avoid a traditional Dutch birth -- at home and with no pain relief.

But since the arrival of my bouncing baby son, I have become a convert to at least one aspect of the Dutch health system -- home care for a week after birth by a maternity nurse who does everything from nappy-changing to cleaning and cooking.

The Dutch philosophy is that childbirth is a natural physical process that should not be medicalized unless there are complications, and should primarily be handled by midwives at home rather than by doctors in a hospital.

The Netherlands has the highest rate of home births in the western world at 30 percent, only 10 percent of women in labor are given pain relief and caesareans are relatively rare.

In contrast, about a third of babies are born by caesarean in the United States ... while only a tiny fraction of women have home births. Midwives who assist home births can even be prosecuted in some U.S. states.

Stunned that the Dutch believe labor pains are important for helping develop the mother-baby bond, I researched the anesthesia policy at all the nearby hospitals only to discover that there was no guarantee of drugs at any of them.

The prospect of a home birth became all the more real when I was advised to have medical supplies on hand -- including swabs and an umbilical cord clamp -- and when metal stands were delivered to raise our bed to help the midwife during delivery ...

HOSPITAL VS HOME?

As it turned out, complications meant a home birth was out of the question and I was induced in hospital on April 27 with an opiate-based pain relief available at the touch of a button.

Delirious for much of the experience, my most abiding memory is screaming at my journalist partner to put away his notebook just before baby Oscar arrived at 9.27 p.m., weighing 4 kgs.

Most of the women from my birth preparation class had a more Dutch experience: none were offered pain relief and one labored at home for hours despite repeated calls to the midwife, who turned up less than an hour before the arrival of baby Kaya.

... questions are now being asked about whether the country's philosophy increases risks during birth.

"Giving birth at home, a unique Dutch tradition, should not be a goal in itself. What really matters is a good result of the pregnancy for mother and child," Jan Nijhuis, Maastricht professor of obstetrics and gynecology, wrote recently.

... gynecologists are also considering a new guideline that would give pregnant women the right to pain relief in hospitals, something they are currently often denied because anesthetists are not on duty at night or because it is not seen as medically necessary during labor.

... "It would be a shame to lose our Dutch system and treat birth in a medical way as if it is a disease. ..."

Melissa Maimann, Essential Birth Consulting 0400 418 448