Not so long ago, healthy pregnant women in the Netherlands who wanted to give birth in a hospital, rather than at home, were rare. They were usually foreigners who didn’t trust or understand the medical system. Now, says Amsterdam-based doula Maartje Bruning, a “vast majority” of her clients don’t plan to give birth at home — and before they consult with her, starting at about 20 weeks of gestation, they have “heard potential horror stories [from] peers or have read stuff online,” Bruning says.
In 2005, nearly 30 percent of Dutch babies were born at home. By 2016, that figure had plummeted to 13 percent.
Home birth has long been a standard option for Dutch women with low-risk pregnancies, even as many other nations have seen hospital births become de rigueur. And the Netherlands’ current home birth figure is still by far the highest in Europe, while the number in other countries is typically less than 1 percent. That’s partly due to an abundance of highly educated Dutch midwives who held the line in the postwar period by being both competent and far cheaper than hospital deliveries.
That still holds true today: A woman who wants to give birth in a hospital under a midwife’s care but has no complications pays a few hundred euros to do so unless the midwife finds a medical reason to refer the expectant mother for hospital services.
So why the waning enthusiasm in the Netherlands for home delivery in recent years? One reason may be bureaucratic, according to Dr. Martine Hollander, an obstetrician at Radboud University Medical Center in Nijmegen. “Every new protocol comes up with more reasons for interventions, and for every intervention, a referral is necessary,” she explains.
The optics of giving birth may also play a part: As with most other places in the world, people in the Netherlands are inundated with American films and television — and in those fictional settings, births almost always happen in hospitals. If people see only births in hospital settings, Hollander explains, that becomes the norm. “The less people have a certain experience, the less the next generation will choose it,” she says. “Nowadays, many young women in their 20s only have girlfriends who had a hospital birth.”
Our midwives are very passionate, hardworking women.
Maartje Bruning, Amsterdam doula
There’s also the pain factor. In a hospital you can have an epidural or a similar procedure, and many women may want pain medication close by.
For Bruning, who’s been a doula for about five years, the drop-off in the home versus hospital stats can be traced to a 2008 report that found a higher rate of infant mortality in the Netherlands compared with other EU countries. That, she says, gave insurance companies and hospitals a chance to lobby the Hague to change regulations and give medical centers an advantage over midwives, who work at home and in conjunction with hospitals. “Our midwives are very passionate, hardworking women, but they didn’t have the same power in the Hague,” says Bruning, who, as a doula, often consults on home births but doesn’t have the same medical training as a midwife.
Meanwhile, in the U.S., paradoxically, home births are on the rise. They fell from being ubiquitous in 1900 to just 1 percent of births in 1969 and have remained rare — but saw an increase in popularity, particularly among White women, rising from 1.2 percent of births to 2 percent between 2004 and 2012. However, according to The Lancet, the U.S. maternal mortality rate as of 2015 was 26.4 per 100,000 births and climbing — more than four times the rate in the Netherlands, which is 6.7.
Explore the world
This year, OZY is going Around the World, bringing you untold stories from every single country on the map, one day at a time, to introduce you to new people, new trends and new places.