Dutch gynaecologists want specialised natal care

23rd November 2009, Comments 9 comments

In a TV documentary, Dutch gynaecologists blame high number of infant fatalities on home births and late intervention practices.

The Netherlands – Dutch gynaecologists say births should only take place in specialised hospitals as intervention comes too late in a television documentary that was screened on Sunday evening.

On current affairs TV programme Zembla, the gynecologists blame the relatively high number of infant fatalities in the Netherlands partly on the practice of home births and say midwives are reluctant to intervene when women in labour get into difficulty.

The claim is vehemently disputed by midwives who said women in labour are rushed to hospital as soon as complications arise.

Around 30 percent of all babies are delivered at home by midwives.

de Volkskrant reported that several gynaecologists have called for the establishment of 40 specialised hospitals throughout the country. These hospitals should provide specialist pre and post natal care where a gynecologist and an anaesthetist should be on duty at all time.

Dr Paul Reuwer said the Netherlands needs specialised birthing centres with gynaecologists on duty day and night in order to improve infant mortality.

Currently, there are 100 hospitals in the Netherlands where women can give birth. However, gynecologists and anaethetists are only present during office hours which mean valuable time is lost when they have to be called up.

The gynaecologists also said that the lack of gynaecologists, surgeons and personnel capable of performing a caesarean section contribute to infant deaths, "by the time a specialist has been drummed up, much valuable time has been lost valuable".

The number of babies in the Netherlands that die just before or just after birth is relatively high compared to other Western countries. A steering group is due to give its recommendations at the end of the year to reduce the infant mortality figures.

Radio Netherlands / Expatica

9 Comments To This Article

  • cb posted:

    on 24th November 2009, 07:07:35 - Reply

    Sorry-- form cut off the rest of my comment. They (the midwives) also told the doctors that they shouldn't encourage me in my fears. Anyhow, I didn't have first time mother jitters. I had severe early onset preeclampsia/HELLP and we lost the baby in the third trimester. I think that it is also worth noting that doctors will not willingly intervene with premature infants under 27 weeks in the Netherlands. This is much later than in many other countries, and may account for some of the difference in the statistics as well.
  • cb posted:

    on 24th November 2009, 07:04:12 - Reply

    I suppose that the midwives are responsive to something being wrong if it is obviously wrong. In our case, we were seen by the gynecology practice at a local hospital because of my past medical history. They had a mixed group who saw patients, including both midwives and doctors. The midwives were the first line, and in our case fought to keep us from the doctors-- and even noted in my file that they thought I was just suffering from first-time mother jitters
  • Jaded posted:

    on 23rd November 2009, 16:42:50 - Reply

    The WHO has advised "what and why" on this issue. The Netherlands response was to FINALLY allow two ultrasounds or as they call them Echo's during pregnancy. They did nothing else. They NL's response is typical well it is only immigrants whose babies die, or older woman etc. This is false , but lets say it is true for the sake of argument. Any preventable death of a child is worth doing something about it!
    My argument is that it is impossible statistically to say only older mothers and immigrants have babies who die. Silly really, in fact in other European countries such as Germany follow a trend to have babies at an older age meaning over age 30.
    The problem is the gynecologist, midwives, ER staff, hospitals etc are not trained to deal with complications. Many coutries have specially trained GYNs that only deal with pregnancy.
    I have heard too many stories of late arriving midwives and how they waited until it was a major complication before getting a woman to hospital to disagree with the statements in this article. I have 3 friends who all had issues like this...
    Osita why do you compare having a healthy alive baby to the USA? In Europe many babies are born in hospital, not just the USA...Have you had a baby in the USA?
    I had my baby here, I was high risk so I was lucky to get a GYN/hospital birth and I was induced. So I could get pain relief after a very long difficult labor.
    But many woman are delayed help, pain medications even during a painful birth like breach births for example because there is not ANY ER staff after midnight ! To have to wait 30 minutes for anyone to help you is a serious issue. Is say 30 because that was what I was told was the "normal" time it takes the ER professionals to show up after they are paged. Not to forget many women are told the hosptials are full and are turned away! How can a modern country not have enough beds to have babies, an ER staff 24 hours?
    The system here for babies and emergency care is horrible and needs serious improvement. I am sure some midwives are wonderful but the lack of equal quality is apparent. Babies lives should not be left up to the luck of the draw and if they are born during office hours etc... These are preventable deaths! To the person who gave the idiot analogy of choking on food, disease it is not, eating it is not this is peoples lives. If you want to stay back in the old days and not use advanced medicine to save lives well I suggest you eat your words and do not gag on em! Back in the day childbirth was the leading cause of death to woman and many babies died, due to improvements in time we no longer have to worry of death when we give birth...but your suggestions state we should.
  • Dawn posted:

    on 23rd November 2009, 12:51:50 - Reply

    Finally! Some truth is spoken about the dodgy system in the Netherlands. The neonatal death statistics for the Netherlands are an on-going national scandal.
  • Ina posted:

    on 23rd November 2009, 12:51:07 - Reply

    Hey, LJK you are a Dutch for sure (or you think like one). If you want to give the birth home, it is your choice and you have to accept the eventually complications. If I want to delivery at hospital why do you think I think or the doctor treat “the birth as a disease”? If you deliver in the hospital the baby is not taken away from you for tests (maybe except the situations the baby has the risk for some diseases/ complications). It is the first time I hear this! And if you do not to happened it you have to say.
    The fact is that The Netherlands places on the second place in Europe (after France) qua postnatal mortality. In the report I read that the cause for these was not giving the birth home, but the inability of neonatologists to help babies! So it is more than simply judge the situation through the wish to delivery home or in the hospital.
  • leeam posted:

    on 23rd November 2009, 12:26:17 - Reply

    i partly agree with the comments by mentioned in this article.

    i disagree that midwives don't want to intervene. my first child i called the midwife when my waters broke. she was there in about 15 minutes and immediately told me to go to the hospital.

    i do agree that even when you deliver in hospital, if you deliver outside standard hours you may have delays. i have received epidurals etc outside of office hours no problem, but when the gynae declared i needed an emergency c-section at about 4pm on a sunday, they had to call in support staff, and a top surgeon and i was wheeled down dark corridors and had to wait while they prepped an operating room as everytthing was shut down for the weekend. the emergency c-section only started 1.5 hours after they declared i needed it. there were gynaes and anaesthetists in the hospital, but they were not ready for emergecny c-sections.

    so i would say that the dutch system is just not ready for complications in birthing process. small things they can handle, but if something serious happens, and it happens outside of office hours, you take your chances. and, just for the record, i delivered both my kids in a top hospital in a major city here in NL. i do agree that the idea of 100 hospitals specialising in births might be an excellent idea if they have necessary staff available 24/7. it would also be important that whoever is working with pregnant women or those in labour be trained to help the women emotionally too. that side of things is severely neglected in Holland (in my opinion) - a happy mother makes for a better pregnancy and safer/better birthing process.
  • LJK posted:

    on 23rd November 2009, 12:04:56 - Reply

    This is total BS! Proof that you can say anything even if it isn't true.

    Just from my OWN experiences I can tell you that 9-5 business isn't true. I HAD to have both my kids in hospital because I had to be induced. I was ok with that. For both children I opted for epidural and both happened very late or early in the morning. We pulled a dr out of his bed at 1am to come give me an epidural and not once was I made to feel ike a burden!

    I feel for the midwives here. They are incredible people who sacrifice so much to care for mothers and babies. If I were able to not go overdue, I would try for a home birth without drugs. That's my goal should I have a 3rd.

    This is NOT America and I'd hate to see home births ended here all because of a bogus claim like this article. If it's all true, show me the studies, the numbers, THE FACTS! No, this is all heresay.

    Here are the facts for those who are curious:

    The most obvious reasons for the high rate of baby deaths in the Netherlands: Dutch mothers are older than in many other countries, many are undergoing fertility treatment, there are more multiple births and perhaps more pregnancies in ethnic minority communities where economic and educational circumstances could play a role. All these factors mean the chance of complications or death during or immediately after birth are high.

    But it's not the traditional Dutch home birth system that accounts for the high perinatal fatalities, according to a not yet published report commissioned by the country's health department. The number of babies that die during home births is not higher than the fatalities that occur during hospital births.

    Love this one:

    “We all eat food everyday,” says Susan Hodges, president of Citizens for Midwifery, who steadfastly refers to birth as a normal, every day bodily function. “Every once in awhile, someone chokes on the food…but we don’t say that you can’t eat a meal unless you’ve got a trained doctor sitting next to you in case you choke.”

    Not every birth needs to be treated like a DISEASE. Your home is in most cases, the safest place to give birth. Why would you WANT to give birth in a place where people are sick and could make your newborn baby sick? Who enjoys having their babies taken away from them for tests and other nonsense? I was so lucky that my MIDWIFE took the time to make sure that the people who took care of us in the hospital knew my previous history with the traumatic HOSPITAL birth of my first child and made it a healing experience for the 2nd child. I had to make it clear that no one would take my baby from me or else I'm sure they would have.

    If you are pregnant in NL and reading this, be clear in your demands. You may think the only result is a healthy baby, but the birth experience matters too. YOU matter too! Make sure you've done what you can do ensure it's as awesome as it can be!

  • osita posted:

    on 23rd November 2009, 11:25:22 - Reply

    Talk about the pot calling the kettle black; the gynacologists can hardly complain about midwives when they themselves only work 9 - 5! Considering that most babies are born outside those hours, it would still be a case of waiting for an on-call gynacologist to arrive in an emergency, even if the mother was in hospital for the whole labour. How would this help make the birth process safer?

    I think these 'doctors' should be cleaning their own doorstep, before pointing at those of the neighbours. It's always everybody elses fault...
  • ratkat posted:

    on 23rd November 2009, 11:00:45 - Reply

    I saw this documentary and found it very disturbing. The midwives disputing the claim is disgusting, but totally in line with the dismissive and stupid attitude shown time and again by the Dutch medical community.