A couple of weeks ago we talked about the call of ENCA, a congress in which associations of users and professionals related to childbirth would meet. Today I bring you a summary of the most interesting presentations, and start with the one related to Childbirth in Holland.
With the title “The reality of giving birth in the Netherlands“The speakers Thea van Tuyl and Hannie Oor professionals in education and childbirth preparation and members of ENCA Holland developed a theme to which the attendees were very attentive, since Holland is considered a role model in their delivery care and especially to home delivery.
When a Dutch woman discovers that she is pregnant she goes to her midwife by choosing among the professionals in her area. Normally in each area there are several midwives and it is normal for women to choose a team consisting of several midwives and meet them all before giving birth. You will have, in the case of pregnancies without problems, about 10 or 12 visits with the midwives of the team and one of those will be the one who attends it when you go to give birth.
The woman can choose a gynecologist, but in fact it will only be covered by your medical insurance if there are reasonable grounds that indicate a pregnancy with some risk. If it is pregnancy, it is normal that the caregiver will be the midwife.
Among the complications in which attention is indicated by an obstetrician are multiple pregnancies, placement in buttocks or hypertension, to name a few. There are lists of complications that require attention by the obstetrician and involve a clear differentiation in the areas of responsibility of one or another professional.
Two scans are performed per ultrasound in each pregnancy, one between 10 and 14 weeks and another at 20, in order to detect malformations in the fetus. They can be done in the midwife's office or in the hospital.
The most identifying feature of the system of attention to childbirth in Holland is that women who have a pregnancy without problems have several options when giving birth: you can do it in a hospital or at your own home. It is also the woman who decides who will accompany her at birth. You can also choose if you want anesthesia, but in this case it will be considered a medical case and will be treated by the obstetrician as there are side effects and problems that can arise directly from the application of pain relief by unnatural means. Of course, the woman decides the posture in which you want to give birth.
30% of Dutch women stop at home. The percentage is higher in the countryside and somewhat lower in the cities, but the overall figure of the country is this. Midwives receive specific training aimed at attending delivery at home safely and will be assisted by a home nurse who will also meet the woman beforehand.
On home delivery in the Netherlands they run all kinds of absurd stories that try to explain the reason why in one of the most developed countries something is practiced that in others is considered something insanely dangerous. Nor is it true that Dutch women have a perfect pelvis, nor that they are more apt to ride a bike, nor is it true that there is an extraordinary ambulance service waiting for transfers.
If a woman gives birth at home there is no ambulance waiting at her door. The midwife visits her to check the progress of the birth process and leaves if the time has not come. If the woman needs help or if she has already entered the second phase of labor, the midwife remains by her side.
When the matron detects a problem indicates the transfer to the hospital and accompanies it until it is in the hands of the obstetrician. Sometimes the transfer is by private car and other times an ambulance is requested. It depends on the situation and the moment of the birth process in which they are. There are no great distances in Holland and the transfer is done quite quickly. In all deliveries, the midwife will have foreseen that a transfer may be necessary since there is no birth in which 100% can be assured that everything will be fine. But it is previously planned. Women trust the midwife and know they will be transferred if necessary.
The one home birth It is allowed to perform the episotomy if necessary but there are no more medical interventions than that, which also happens only in some cases counted. Keep in mind that at home the woman gives birth in her room or in her bathroom or in her living room. There are no dangerous hospital bacteria.
If the baby needs some oxygen, the midwife takes it in her kit. But if the problem is more serious, you will be transferred to the hospital. A transfer after childbirth may be necessary for this reason, or for placental retention, bleeding or tearing.
It is considered that the home birth It is as safe as a hospital birth and in some cases even safer.
Recently an investigation has been opened to re-determine the safety of home birth, since the perinatal death figures were higher than in other countries. However, the conclusion has been that these figures are due to other factors: high maternal age in primigests (one in five is over 35 years old), the high percentage of multiple pregnancies due to in-vitro fertilization, the high rate of immigrants who do not know the health system and do not use it or have tobacco in pregnancy in the most disadvantaged classes.
In Holland home birth is safe, since only healthy women are selected and because the distance to the hospitals is small being the maximum transfer time of 15 minutes, in addition to having the midwife with a specialized nurse who helps her.
It is normal to choose to give birth at home, most women consider their pregnancy as a natural event, not as an illness. However, if they fear childbirth at home they can choose to give birth in a hospital, but if there are no medical causes that advise its use the woman must pay the stay and to the particular midwife. The health system does not offer this service for free because it considers it unnecessary and in any case who will attend it will be a midwife if the delivery is normal.
The discharge, if everything is correct, is very fast in all cases.
When there is a problem, the woman will give birth with an obstetrician. This can be determined during pregnancy (incorrect baby placement or high blood pressure). But it may also be necessary to refer you to the doctor during the delivery itself. It will be an obstetrician who treats her if anesthesia is required or if after birth there is bleeding. Midwives have very clear cases that exceed their responsibility.
Recently it has been indicated that the health system must be able to provide epidural anesthesia to any woman who requests it within a maximum period of one hour, but so far it is not possible although it is a request that more and more women make. However, midwives and nurses at home continue to provide non-pharmacological pain relief techniques: massage, walking, relaxation, breathing exercises, visualizations or baths, in addition to the enormous psychological importance that women have the usual presence of doulas in your births
Know first hand the childbirth care system in the Netherlands It allowed me to discover that particularities of this country are extrapolated to ours and which are not.
Home delivery, in places where the transfer can be guaranteed in adequate time if necessary and with the care of trained midwives would be, in my feasible opinion, and in addition to safe and emotionally healthy, it would imply a rationalization of health resources to the cases that need it. In any case, in hospitals, there may be a certain area for normal deliveries, in which the woman who cannot or does not want home delivery can be attended by the midwife. It is true that Spain could not provide home delivery in all cases, especially because of the remoteness of some population centers, nor could it be imposed if the woman does not want to, but considering home birth as dangerous is revealed as an error. .
It should also be noted that in Spain the midwife is a nurse who specializes in this field, and in other countries the training is specific from the beginning of the studies. As we have seen, childbirth in Holland, it is the responsibility of the midwife and she decides, on a specific case, when it becomes a case that the gynecologist will take.
