©Pregnancy bliss 2008

Different countries: Why the Difference?

It is rather puzzling to see the stark differences in rates of home births between neighbours like the Netherlands and the UK.  The explanation lies in the cultural difference between the Dutch and the British when it comes to childbirth. The whole approach is therefore different. This is seen in other statistics including the cesarean section rate which has hovered around 10% in the Netherlands for years as compared to the ever-rising rate in the UK, now approaching 25%.

Whilst most midwives in the UK are employed by the state via NHS Trusts and therefore are hospital-based, in the Netherlands they are independent practitioners, a situation which is supportive of the home birth option culture. Moreover, in the Netherlands there are maternity assistants, the so-called kraamverzorgsters, who are available for every new delivered mother for up to eight days for up to eight hours every day. The cost of this service is paid for by the state. Community midwives do make postnatal home visits in the UK but this is just to ensure all is well with mother and baby and give any practical advice that might be required.

 

Home birth: Suitable for everybody?

Needless to say, home birth would not suit everybody. Moreover, it is important to be realistic about a mother’s expectation. In places like Holland where the practice is established, statistics show that up to a third of all women do eventually have to be transferred to hospital to conclude their delivery there. This is usually for a variety of reasons which include

· A slower than expected labor

· Unbearable pain requiring strong pain killers

· Features suggesting distress of the baby

· Unexpectedly difficult delivery

In the initial risk assessment, a mother with ambition for a home birth might be advised against it in the presence of such factors as:

· Development of gestational diabetes

· Increased volumes of amniotic fluid

· Fetal  growth restriction

· Breech presentation

It is also unlikely that a midwife will be prepared to assist a home birth in cases of:

· Multiple pregnancy (twins)

· Previous cesarean section

· Previous unexplained stillbirth

Midwives are also reluctant to support a quest for a home birth if it is a first pregnancy.

What is important is to ensure all bases are covered. The structure has to be in place to ensure continued communication between the assisting midwife and the local hospital. In addition, a smooth transfer to hospital, always via ambulance, has to be available should the need arise.

Home Birth needs to be available for those who desire this option and who are deemed suited to it. It is important that health provision authorities, in the UK, the NHS Trusts, facilitate this.

Next Section: Inducing your own labor