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Maternity Care in The Netherlands: The Changing Home Birth Rate

Authors

  • Therese A. Wiegers PhD,

    1. Therese Wiegers is a Research Fellow and Jouke van der Zee is Professor and Director at The Netherlands Institute of Primary Health Care, Utrecht, The Netherlands; Marc Keirse is Professor and Head, Department of Obstetrics and Gynaecology, Flinders Medical Center, Adelaide, South Australia, Australia.
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  • Jouke Van Der Zee PhD,

    1. Therese Wiegers is a Research Fellow and Jouke van der Zee is Professor and Director at The Netherlands Institute of Primary Health Care, Utrecht, The Netherlands; Marc Keirse is Professor and Head, Department of Obstetrics and Gynaecology, Flinders Medical Center, Adelaide, South Australia, Australia.
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  • Marc J. N. C. Keirse MD, DPhil, FRACOG, FRCOG

    1. Therese Wiegers is a Research Fellow and Jouke van der Zee is Professor and Director at The Netherlands Institute of Primary Health Care, Utrecht, The Netherlands; Marc Keirse is Professor and Head, Department of Obstetrics and Gynaecology, Flinders Medical Center, Adelaide, South Australia, Australia.
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Therese Wiegers, PhD, NIVEL, PO Box 1568, 3500 BN Utrecht, The Netherlands.\cW 1998 Blackwell Science, Inc.

Abstract

In 1965 two-thirds of all births in The Netherlands occurred at home. In the next 25 years, that situation became reversed with more than two-thirds of births occurring in hospital and fewer than one-third at home. Several factors have influenced that change, including the introduction of short-stay hospital birth, hospital facilities for independent midwives, increased referral rates from primary to secondary care, changes in the share of the different professionals involved in maternity care, medical technology, and demographic changes. After a decline up to 1978 and a period of relative stability between 1978 and 1988, the home birth rate started to decline further, to the extent that it might destabilize the Dutch maternity care system and the role of midwives in it. The Dutch maternity care system depends heavily on primary caregivers, midwives and general practitioners who are responsible for the care of women with low-risk pregnancies, and on obstetricians who provide care for high-risk pregnancies. Its preservation requires a high level of cooperation among the different caregivers, and a functional selection system to ensure that all women receive the type of care that is best suited to their needs. Preserving the home birth option in the Dutch maternity care system necessitates the maintenance of high training and postgraduate standards for midwives, the continued provision of maternity home care assistants, and giving women with uncomplicated pregnancies enough confidence in themselves and the system to feel safe in choosing a home birth. (BIRTH 25:3 September 1998)

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