Controversy over home births in the Netherlands

Eke Ut Mannetje and daughter Santje

A debate is raging in the Netherlands about where women should give birth.

It is the country which has always had the highest rate of home birth in Europe - although the figure has dropped from 34% of births to 24% during the past decade.

The decline has been particularly dramatic in the past two years.

Media reports have raised questions about the safety of home births. Some experts say these are scare stories though.

On a maternity ward in a big Amsterdam hospital, the OLVG, health journalist Hester van Yperen is proudly holding her son.

He was born by Caesarian section three days earlier. The operation was planned because the baby was in the breech position.

'Too risky'

Hester, 37, has reported on the safety of home births for the Dutch TV channel, RTL.

From her hospital bed, she told me why she'd never wanted to give birth at home.

She said: "Dutch women grow up thinking home birth is good for you, and that it's part of mother nature.

"But I didn't consider it at all. I think it's too risky. If something is wrong, it's better to be in hospital."

The Dutch government has described as "worrying" the fact that the rate of death among newborn babies is higher than in other European countries.

The health minister said recently that obstetric care needed to improve, and there was sometimes "insufficient communication" between professionals.

Professor Gerry Visser

Some doctors say women are choosing hospital birth because they want a full range of pain relief and quicker deliveries.

In the peaceful commuter town of Soest, it is easy to find women who hold dear the Dutch culture of a high rate of home birth.

Eke Ut Mannetje has delivered all three of her children at home.

Eke said: "You have all the bacteria and ill people in hospital. Emotionally, you want to hide in surroundings that you know and have comfort when giving birth. For me, being at home was perfect.

"The birth of my first daughter, Sient, who's now seven, went really quickly. We lived on a fourth floor home in Amsterdam at the time.

"The midwife had to run to get to me in time. We lived close to the hospital - but she said if there were complications, I'd have to stay horizontal and the firemen would have to get me out of the window. I was glad that wasn't the case!"

'One big disaster'

Christine Coenen delivered her daughters Fean, 10, and six-year-old Do in hospital - although she would have preferred home birth. It was what her own mother had done with 10 children.

But Do was three weeks late in arriving. Christine was suddenly rushed to hospital with contractions.

The placenta was late in being delivered, and she lost a lot of blood.

Christine said: "There is no guarantee you won't have complications at home - but I know from experience that there's also no guarantee you won't have complications in hospital either.

"What happened to me was one big disaster. It's not nice being driven to hospital while having contractions and being in pain."

One unique feature of the Dutch system is a network of maternity nurses called Kraamhulp.

They assist midwives during the birth, help new mothers begin breastfeeding and provide vital back-up during the crucial first week with maternity care and even housework.

One of them, Sylvia Dorrestein, told me: "It's emotional and intensive but also a really nice job. I've been doing this for 15 years.

"You have to learn how to raise a child in the home - not in hospital."

But critics of the system say it has been too hesitant in considering risk.

The charge is being led by Professor Gerry Visser, an obstetrician at Utrecht Medical Centre.

He said: "There's been this mentality of 'don't be too aggressive - they're healthy women - it can't be too serious'. Generally that's correct - but not always.

"The rate of intervention here is too low. We fell asleep. And now the higher mortality data has given us something of a crisis."

Unfairly blamed

Last year in the Netherlands, there were around 1,700 stillbirths and deaths among newborn babies.

Everyone agrees that figure is too high, and that Dutch midwives and doctors should work more closely together.

But are home births being unfairly blamed?

Professor Simone Buitendijk leads midwives' training and researches the Dutch maternity system and international mortality rates. She is dismayed at the recent drop in home births.

She said: "Thirty of those 1,700 deaths were after the mother started to give birth at home - and not all of those 30 are avoidable.

"Home births are safe. Even if we totally abolished them, we wouldn't make a small dent in the mortality statistics.

"It's very short-sighted. I think it would be really sad if choice disappears - and there's a real risk of this happening in the Netherlands.

"It has nothing to do with a painting over the bed, or a nice soft light in the corner. Home birth for women is the best possible way of being properly in control. It's so elementary and important."