WITNESS: No pain, no gain? Giving birth Dutch-style

Thu Mar 27, 2008 11:03am EDT

Emma Thomasson leans over her son, Oscar Shaxson, a day after his birth at Lucas Andreas Hospital, Amsterdam April 28, 2007. REUTERS/Handout

Emma Thomasson leans over her son, Oscar Shaxson, a day after his birth at Lucas Andreas Hospital, Amsterdam April 28, 2007.

Credit: Reuters/Handout

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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.)

By Emma Thomasson

AMSTERDAM (Reuters) - 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 and about 20 percent in Britain, 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.

With my due date set for May 1, I nervously joked I might be in labor on labor day. Then I realized I might not be able to get to hospital in an emergency because of the partying throngs celebrating the April 30 Dutch national holiday.

A Dutch neighbor offered to have his boat at the ready to ferry me from our canal-side home if necessary, but I decided to make contingency plans to stay near the hospital instead.

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.

I must admit the Dutch brainwashing left me a bit disappointed I didn't have a chance to put my months of yoga practice and breathing exercises to good use in a natural birth.

But 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.

He argued that births should be centralized in about 30 to 50 maternity hospitals, staffed around the clock by gynecologists, anesthetists and other specialists.

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.

Petra de Bruin, the birth assistant or doula who ran my prenatal class, says she would like it to be easier to get pain relief, but defends the Netherlands' overall philosophy.

"It would be a shame to lose our Dutch system and treat birth in a medical way as if it is a disease. I think it is good to think of it as a natural process," she said.

One element of the Dutch system is universally supported -- the 'kraamzorg' or maternity nurse who offers after-birth care. David Cameron, leader of Britain's opposition Conservatives, is so impressed he wants to introduce similar nurses there.

Mine turned up just a few hours after we got home from hospital and set to work making dinner and teaching me and my partner how to swaddle Oscar to help him sleep.

For the next week, she did daily health checks on both of us, helped me breastfeed, and taught us how to bathe the baby and put him to sleep -- on his back by the window to prevent cot death and jaundice -- among dozens of other practical tips.

It was great to be cared for at home rather than in hospital and the nurse gave me such confidence. Perhaps, if I decide to have another baby, I'll go Dutch.

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