Midwifery in the Netherlands
By: Eric Parlin
Tags: Midwife, Pregnancy, Netherlands, Healthcare, Birth

In the Netherlands midwives are highly regarded within society. Unlike, many other countries, the Netherlands only has one type of midwife. Furthermore, the Dutch government has recognized midwives as independent medical practitioners since 1865. As a result, of this acknowledgement, Dutch midwives must adhere to specific standards of education. They must attend one of four schools that specialize in midwifery. These programs last approximately four years. After this time, the student will earn a Bachelor’s degree in midwifery. Students also have the option to follow a midwifery Master’s Program. In order to be accepted to these programs students must have A level equivalents in chemistry, biology, and English language.

While at these midwifery schools, students are taught basic sciences. In addition, these programs emphasize the methods for successful deliveries during a birth without complications. But these schools have specific sections in which midwives are trained to handle abnormal births. Finally, most of the midwives in the Netherlands are private entrepreneurs. As a result, the Dutch midwifery school’s curriculum teaches their students how to be successful independent practitioners.

Dutch midwives additionally have an unusual amount of power. In most countries midwives are restricted in the actions that they are allowed to perform. But midwives in the Netherland are much less restricted. Dutch midwives can do blood work on their patients in order to give thorough diet advice. In addition, midwives in the Netherland are allowed to perform episiotomies under local anesthetics and to prescribe antithesis (D) immunoglobulin. In the United States only doctors are permitted to prescribe this medication. Moreover, the expansive power of Dutch midwives allows these medical professionals to more fully assist their patients.

Also, in the Netherlands there are policies in place to minimize the historical competition between doctors and midwives. In other places, this conflict has led to negative complications, such as the discrediting of midwives and the loss of many midwifery practices. But, in the Netherlands these groups appear to be in collaboration rather than competition. This collaboration stems directly from the Dutch’s insurance reimbursement process.

In the Netherlands births are divided into three risk categories: low-risk, medium-risk, and high-risk. These groups are determined on the bases of 124 symptoms. Insurance companies will only reimburse low-risk patients for the cost of seeing a midwife or a general practitioner. Individuals in the medium risk are advised to see an obstetrician for whom their insurance will pay. However, the patient giving birth is allowed to decide whether or not to have a midwife oversee their delivery. Lastly, high-risk births must be overseen by an obstetrician.

As a result, of having a distinct rubric which decides if a patient is seen by an obstetrician or midwife, there is not a lot of competition between these groups. Obstetrician and midwives are seen as two distinct medical professionals that serve completely different roles in the child birthing process. Furthermore, in births where obstetrician’s intervention is necessary, midwives are expected to stay with the patient. This stems from the idea that midwives serve a different role to the doctor. Therefore, it is seen as necessary for the midwife to stay and aid the doctor and the patient. As a whole, this collaborative doctor/midwife dynamic helps the patient since these medical professionals work together to care for patients.

The high number of midwives in the Netherland also aid the Dutch populous by reducing the C-section rate. Most developed nations have a much higher ratio of doctors to midwives than the Netherlands. For example, in 2002 only 8.1 percent of births in the United States were overseen by a midwife. On the other hand, 33.4 percent of births in the Netherland were delivered with a midwife. In the United States the high number of OBGYNs often leads to unnecessary interventions. OBGYNs can be sued if a death occurs in a situation in which the they did not take the most invasive action. Thus, OBGYNs often perform unwarranted cesarean sections in order to forestall legal action.

In the Netherlands, though, there is a much lower rate of Cesarean sections. Midwives do not perform this operation. Hence, this lower cesarean section rate likely stems from the higher percentage of midwives practicing. The percent of obstetricians has been on the rise in recent years and the C-section rate has nearly doubled from 7.5 percent in 1990 to 13.8 percent in 2004. But the C-section rate is still less than half that of the United States and within the range recommended by the World Health Organization. Overall, the Netherlands has an effective obstetric model with a relatively low C-section rate as a result of the higher percentage of midwives practicing

In the Netherlands midwives are also supported by a maternity home care assistant. The occupation of a midwife is extremely strenuous and time-consuming. People in this field of work may be called at any time of day to oversee a birth. In order to relieve some of the stress from midwives, the Dutch integrated in a maternity home care assistant. This maternity home care assistant takes care of the new mothers and their babies each day during a lying-in period. As a result of this assistant managing postnatal care, the burdensome workload of midwives is reduced.

If the maternity assistant notices anything unusual, they are advised to contact a midwife. Furthermore, the Dutch maternity home care assistant has a wide range of jobs related to monitoring health, such as checking the baby’s progress and temperature. In addition, the maternity assistants do house work, such as going grocery shopping and cleaning. This position of maternity home care assistant is vital for Dutch midwives because it significantly relieves their workload. Thus, Dutch midwives can focus all their attention on safe deliveries for mother and newborns.