The System, the Cult and the Greed
In the Dutch system midwives care for the pregnant women from the start of the pregnancy, till about a week after delivery. At some point during birth, or after, a carer who is not a real nurse (kraamhulp) will come to help with the baby. This person will come each day for a few hours for about 7 days.
Doctors may be involved if something goes wrong during the pregnancy but there are no obstetricians.
I see you have raised your eyebrows. Traditionally there is this belief that women should be at home always and deliver at home. And that anyway, there is no point in going to a doctor for help.
This worked nicely as a self fulfilling prophecy. When something went wrong during childbirth, the woman would get dumped at the hospital. As this would usually happen at nighttime, with no doctors present she would be left to die with the night-janitor watching over her. Then everyone could say, see, there is no point it going to the hospital and it will be business as usual.
(A similar pattern is followed today by law enforcement when it comes to sexual assault. Police discourage victims from pressing charges, because you see, it almost never leads to a court case anyway. [8,9])
Fast forward to the here and now, such ideas are dwindling. There are still no real obstetricians, but in many places in the Netherlands doctors are available at hospitals day and night to try and assist in childbirth. And to be fair, many Dutch midwifes are highly qualified, they keep up with the scientific literature and even do research.
When it comes to Dutch would-be mothers, for some fulfilling the tradition of housebirth has a special meaning. Some simply believe it is wrong to factor safety in when planning childbirth. Their reasoning consists of rolling of eyes, huffing and raising their voice and stating: "But you could get hit by lightning!".
Often people who hold this belief feel it is ok to force it on others, like any other cult really.
As with most beliefs it is a package deal. This one comes with the auxiliary belief that women who get pain medication are evil witches who should burn in hell. And, as i learned only afterwards, that women should not be allowed to rest the first couple of days after childbirth because that could aid in their recovery and that would be hubris.
It's a cliche that midwives are religiously pro house-birth: some of them are, some of them are not and some evidently lie about their position.
The really ugly thing happens when belief is coupled with greed (same old, same old, i guess).
The number of actual manned beds in the hospital is determined by and payed for by insurance companies. Insurance companies by law are required to 'buy sufficient healthcare' but really it the end its all just bargaining and politics.
As a result some parts of the Netherlands have decent maternity care, in other places care is scarce and only available if you're lucky and in other places there is none. In Amsterdam care is scarce, a dramatic shortage of maternity beds in Amsterdam has existed for years. I had known beforehand that women are routinely booted out the hospital 2 hours after giving birth, just to make room. I didn't know it had gotten so bad there simply is no room at all.
But at least it's not Meppel, where insurance company Zilveren Kruis Achmea closed down the maternity ward to cut expenses. They did this before they even organised sufficient ambulances to drive women the increased distance to the next hospital[1]. One of their arguments was that they still fulfilled the requirement of a hospital being reachable with 45 minutes. However, extensive research tells us that emergencies should be seen to within 20 minutes [2].
The predictable thing happened a few months after the closing: a healthy, full term baby died soon after childbirth through a complication that could have been handled in said hospital [3]. Zilveren Kruis Achmea (aka FBTO, De Friesland Zorgverzekeraar, Pro-Life, OZF) made a profit of 453 million that year. [4]
Lethal greed is not limited to insurers, unfortunately. The same year, a healthy full grown baby died soon after childbirth in hospital because the doctor was double booked. Apparently the Tergooi hospital took insurers money to do an operation and to take care of the birthing mother. Except the doctor could not be both places at the same time so he intervened only a full hour after the emergency, when it was much much too late. [5]
Money that could be spend to employ more doctors and have more beds is spend on other things. One fifth of hospital managers make too much money, exceeding the threshold of a cabinet minister's salary.[6] It's really a matter of priorities, the hospital that was full the night of my sons birth had just installed a bar, yes a bar [7]. FFS
1 https://www.skipr.nl/actueel/id12680-noorderboog-stopt-klinische-verloskunde-meppel.html
2 Travel time from home to hospital and adverse perinatal outcomes in women at term in the Netherlands - Ravelli et al. - BJOG Volume 118, Issue 4 March 2011 pp 457-465
http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2010.02816.x/full
3 http://www.rtvdrenthe.nl/nieuws/87466/Meppeler-baby-overlijdt-door-sluiting-verloskunde-Diaconessenhuis
4 https://www.vergelijken-zorgverzekering.net/achmea-maakt-weer-winst
5 http://www.nhnieuws.nl/nieuws/201544/Ouders-dode-baby-strijden-al-jaren-om-informatie-over-fatale-bevalling-in-Tergooi
6 https://www.skipr.nl/actueel/id32271-eenvijfde-zorgbestuurders-verdient-meer-dan-wnt-norm.html
7 https://www.herman-thijs.nl/moeder-en-kindcentrum/
8 https://www.volkskrant.nl/binnenland/onbegrip-over-verplichte-bedenktijd-bij-aangifte-aanranding~a4110234/
9 https://www.nrc.nl/nieuws/2016/01/15/klacht-over-doofpot-na-aanrandingen-almere-1580590-a1082833
Doctors may be involved if something goes wrong during the pregnancy but there are no obstetricians.
I see you have raised your eyebrows. Traditionally there is this belief that women should be at home always and deliver at home. And that anyway, there is no point in going to a doctor for help.
This worked nicely as a self fulfilling prophecy. When something went wrong during childbirth, the woman would get dumped at the hospital. As this would usually happen at nighttime, with no doctors present she would be left to die with the night-janitor watching over her. Then everyone could say, see, there is no point it going to the hospital and it will be business as usual.
(A similar pattern is followed today by law enforcement when it comes to sexual assault. Police discourage victims from pressing charges, because you see, it almost never leads to a court case anyway. [8,9])
Fast forward to the here and now, such ideas are dwindling. There are still no real obstetricians, but in many places in the Netherlands doctors are available at hospitals day and night to try and assist in childbirth. And to be fair, many Dutch midwifes are highly qualified, they keep up with the scientific literature and even do research.
When it comes to Dutch would-be mothers, for some fulfilling the tradition of housebirth has a special meaning. Some simply believe it is wrong to factor safety in when planning childbirth. Their reasoning consists of rolling of eyes, huffing and raising their voice and stating: "But you could get hit by lightning!".
Often people who hold this belief feel it is ok to force it on others, like any other cult really.
As with most beliefs it is a package deal. This one comes with the auxiliary belief that women who get pain medication are evil witches who should burn in hell. And, as i learned only afterwards, that women should not be allowed to rest the first couple of days after childbirth because that could aid in their recovery and that would be hubris.
It's a cliche that midwives are religiously pro house-birth: some of them are, some of them are not and some evidently lie about their position.
The really ugly thing happens when belief is coupled with greed (same old, same old, i guess).
The number of actual manned beds in the hospital is determined by and payed for by insurance companies. Insurance companies by law are required to 'buy sufficient healthcare' but really it the end its all just bargaining and politics.
As a result some parts of the Netherlands have decent maternity care, in other places care is scarce and only available if you're lucky and in other places there is none. In Amsterdam care is scarce, a dramatic shortage of maternity beds in Amsterdam has existed for years. I had known beforehand that women are routinely booted out the hospital 2 hours after giving birth, just to make room. I didn't know it had gotten so bad there simply is no room at all.
But at least it's not Meppel, where insurance company Zilveren Kruis Achmea closed down the maternity ward to cut expenses. They did this before they even organised sufficient ambulances to drive women the increased distance to the next hospital[1]. One of their arguments was that they still fulfilled the requirement of a hospital being reachable with 45 minutes. However, extensive research tells us that emergencies should be seen to within 20 minutes [2].
The predictable thing happened a few months after the closing: a healthy, full term baby died soon after childbirth through a complication that could have been handled in said hospital [3]. Zilveren Kruis Achmea (aka FBTO, De Friesland Zorgverzekeraar, Pro-Life, OZF) made a profit of 453 million that year. [4]
Lethal greed is not limited to insurers, unfortunately. The same year, a healthy full grown baby died soon after childbirth in hospital because the doctor was double booked. Apparently the Tergooi hospital took insurers money to do an operation and to take care of the birthing mother. Except the doctor could not be both places at the same time so he intervened only a full hour after the emergency, when it was much much too late. [5]
Money that could be spend to employ more doctors and have more beds is spend on other things. One fifth of hospital managers make too much money, exceeding the threshold of a cabinet minister's salary.[6] It's really a matter of priorities, the hospital that was full the night of my sons birth had just installed a bar, yes a bar [7]. FFS
1 https://www.skipr.nl/actueel/id12680-noorderboog-stopt-klinische-verloskunde-meppel.html
2 Travel time from home to hospital and adverse perinatal outcomes in women at term in the Netherlands - Ravelli et al. - BJOG Volume 118, Issue 4 March 2011 pp 457-465
http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2010.02816.x/full
3 http://www.rtvdrenthe.nl/nieuws/87466/Meppeler-baby-overlijdt-door-sluiting-verloskunde-Diaconessenhuis
4 https://www.vergelijken-zorgverzekering.net/achmea-maakt-weer-winst
5 http://www.nhnieuws.nl/nieuws/201544/Ouders-dode-baby-strijden-al-jaren-om-informatie-over-fatale-bevalling-in-Tergooi
6 https://www.skipr.nl/actueel/id32271-eenvijfde-zorgbestuurders-verdient-meer-dan-wnt-norm.html
7 https://www.herman-thijs.nl/moeder-en-kindcentrum/
8 https://www.volkskrant.nl/binnenland/onbegrip-over-verplichte-bedenktijd-bij-aangifte-aanranding~a4110234/
9 https://www.nrc.nl/nieuws/2016/01/15/klacht-over-doofpot-na-aanrandingen-almere-1580590-a1082833