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Birth at home, unique Dutch culture

  The Netherlands has the highest rate of home births in Europe. Since 1990, about one-third of the newborns in the Netherlands have been born at home every year. Although this number fluctuates year by year, it is far higher than that of European developed countries with the same economic level—in neighboring Belgium, Germany, and France, this number None exceed 2%. Women from European countries or other regions often also feel incredible after hearing or witnessing the “system” of Dutch women giving birth at home.
  A Brazilian friend of mine in the Netherlands recently welcomed her daughter Gaia into their home. At first, she was completely taken aback when the hospital told her she would be giving birth at home—”Nobody does that in Brazil!” But the insurance terms forced her to accept it. She was still working until two weeks before giving birth, until one morning she felt her body start to “fire”. Relatives and friends came from Brazil and Poland to be by her side. The length and exhaustion of childbirth was beyond her imagination. Fortunately, the environment at home allowed her to relax, and the company of her husband and midwife made her feel “safe”. The midwife guided her and her husband to symbolically “hold” their daughter’s tiny feet and usher her into the world, a sacred moment that made her and her husband feel more connected to each other – something she didn’t expect to happen Born at home. “I did it”, she said proudly, although she did not become a “family childbirth advocate” because of this, she felt a kind of self-confidence.

A Dutch mother weighs her baby after a home delivery.
Government encourages home births

  In the Netherlands, hospitals provide free midwives to assist mothers in giving birth at home. Medicare only covers hospital deliveries that are assessed as having a risk of dystocia at home due to objective factors (rather than subjective fear) such as advanced age, multiple births, and complications (such as gestational diabetes). Of course, mothers who encounter difficulties or dangers during home delivery will also be urgently transferred to the hospital.
  The Dutch health department encourages Dutch women to give birth at home, which reflects the idea of ​​not “medicalizing” childbirth in public health and the orientation of reducing the burden on the medical system. On the official website of the Dutch health department, there is a “persuasion” article “Under what circumstances should you not see a general practitioner”, the core idea is that if there is no crisis, self-limiting diseases such as colds are Seek medical attention. In the same way, the Dutch health system also regards childbirth as a natural physiological process that does not require medical intervention if there are no known risk factors. Due to the deep-rooted tradition of “non-necessary medical treatment” and the strict referral system of the medical system (in the Netherlands, people cannot go directly to the hospital for medical treatment except for emergencies. All medical needs must be assessed by a general practitioner and referred to a specialist doctor or hospital). The Dutch healthcare system does not have the deficit problems that are common in developed countries.
  The systematic support provided by the Dutch health system for home births is called “Maternity Assistance” (Kraamhulp)-the hospital will arrange a qualified and experienced nurse for the mother in the first trimester to maintain contact with the mother before delivery and build trust. Work as a midwife to assist with labor during labor, provide postpartum care after delivery, and even help with household chores. Ideally, they would provide ongoing care, help and support rather than one-off medical intervention.
Are home births as safe as hospital births?

  ”Birth at home is as safe as giving birth in a hospital”, this is the most popular slogan about giving birth at home. In 2011, a comparative study of nearly 680,000 low-risk births in the Netherlands between 2000 and 2007 showed that there was no significant difference in neonatal mortality between low-risk mothers who gave birth at home and those who gave birth in a hospital. In 2018, a Canadian study of a total of 500,000 low-risk births in the United Kingdom, the Netherlands, Norway, Sweden, and New Zealand reached the same conclusion.
  But opponents of home births have good reasons, too. Giving birth at home means first and foremost without anesthesia. Painless delivery requires professional anesthesia equipment and experienced anesthesiologists, which can only be provided by hospitals. From a medical point of view, pain can cause mental tension and muscle spasms, making it difficult for the mother to focus on exertion, which may prolong the delivery time. Encouraging home births and enduring pain when advances in modern medicine allow pain relief has been questioned as a violation of women’s welfare.
  The risks of childbirth and the uncertainty of receiving timely medical care are more worrisome — opponents point out that just because childbirth isn’t a disease doesn’t mean it’s not dangerous. In 2021, a widely discussed movie “Pieces of a Woman” is about such a situation: the heroine Martha is in good health and has a good pregnancy. She chose to give birth at home with her husband and a trained midwife. From the bathtub to the bed, Martha was unable to deliver the fetus for a long time, and the fetal heart rate dropped sharply. Despite the midwife calling an ambulance, Martha’s fetus died from lack of oxygen.
  There are also many Dutch women complaining on social networks that the continuous support promised by the “Maternity Assistance” system is not complete. Whenever they report discomfort and pain, they will be sent back by the midwife nurse with a “normal situation”, let alone see the obstetrician. “Do not seek medical treatment unless necessary” seems to be a reasonable excuse to keep everyone out of medical resources. While advocates of home births cry for the right to choose, the right of women to freely choose to give birth in a medical facility seems to be disregarded – those who can afford it can always go to a private hospital with private insurance, and those who rely on public insurance are forced to stay at home. childbirth. Although the Dutch don’t have the idea that childbirth is a “closed door”, mothers-to-be also worry about the risks of childbirth and their distance from medical resources when those risks arise.
Giving birth at home requires complete medical escort

  Outside of the Netherlands, there is a quiet resurgence of the “birth at home” movement in the UK, the US and the Nordic countries. Yet a little observation reveals that home birth is a privilege of the developed world—trusting one’s own body means, first and foremost, trusting the medical resources that are there to provide support. Among these resources, the most important are nursing resources. A core concept of home birth is the “de-medicalization” of childbirth. At an operational level, this means shifting medical responsibility from obstetricians to caregivers, including maternity and midwives. At present, developed countries often have developed a professional training system for obstetric nurses, but skilled obstetric nurses are still in short supply.
  Being able to afford an experienced midwife is a privilege in itself. And this kind of privilege is systematized as women’s welfare in some developed countries. A counterexample is that in Sweden, which also implements universal free medical care, because local councils refuse to include midwives’ salaries in public expenditures, home birthers can only hire midwives and nursing staff at their own expense, which greatly discourages Swedish women’s enthusiasm for home delivery. Perhaps a more general counterexample is that in some low-income countries, women are forced to give birth at home without assistance and protection because of the extreme lack of medical resources.

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