The Netherlands certainly has a lot to teach us, especially those of us in the U.S., about a more just birthing system. But it’s not utopian, as many Americans seem to think. There is a pretty large misconception that most women in the Netherlands birth at home – I recently read an assertion that the homebirth rate there was 90%, which is not true.
While about 70% of women start out their care with out-of-hospital midwives, as of 2010 only about 16% of Dutch women go on to give birth at home (this is down from 30% only six years prior) – See this Euro-Peristat Report, p. 95, for more details.
There are myriad, complicated factors that play into the homebirth rate decline, including the ever increasing mainstreaming of midwives into the medical model of care, and media propaganda that spins the relatively high infant mortality rate into an assumed causal relationship between it and homebirth.
While it is not my goal to shatter idealized perceptions, necessarily, I do think it is important to accurately understand and assess the ways in which women are asked to compromise their bodies and their births every day in all parts of the world - even those parts which do 16 times better than the U.S.
My friend and fellow activist, Hermine Hayes-Klein, had this experience to share about birth in the Netherlands. I asked for her permission to share it with you and she graciously agreed.
“In 2007, I was pregnant for the first time and moving to Holland. I asked my partner, who was already there, to help me find a midwife, and he magically came up with an email address for De Oerbron, the business of Erica Muller. I wrote them, and received an email back. It referred me to Laura van Deth, and described her as “one of the best midwives in Holland.”
I met Laura– it was a cosmic reunion. She supported me through the births of both of my children, at home. I have met many amazing midwives in the years since then, but none of them are better at midwifery than Laura. She didn’t just stand by me during birth; she helped me when I needed help, in the ways that I needed to be helped. She did the same for every pregnant friend who took my advice to call her. She is a True Midwife, and through watching her I learned what that means.
In 2010, the Dutch health inspectorate decided that it needed to crack down on the Dutch women who choose to birth twins and breech babies at home. A good way to do that is to make sure that they have nowhere to turn, if they want to walk away from the doctors offering them a) surgical birth or b) vaginal delivery on an operating table with a dozen masked strangers standing around. Laura is one of a handful of midwives in Holland who will show up for physiological twins & breech birth. She got 4 complaints filed against her by displeased medical professionals, after 23 years without any trouble. In no case did the parents cooperate with the complaints. The essential legal issue was whether Dutch midwives can support women in physiological twins/breech births at home.
The cases were heard by the Dutch Healthcare Court, which oversees licensing, in May. Laura was defended by brilliant Ernst Van Bemmelen Van Gent. This week the verdict came down. The judge ruled that midwives are not competent to attend breech/ twins births, that they must be transferred to the hospital/ doctors/ medical folks. He stripped Laura of her license to practice midwifery. He explained that he had to take away her license, because she had expressed no remorse for the wrong of attending these births, and in fact expressed an intention to keep working this way.
I used to think that Dutch women had a real choice for home birth. These cases helped me to see that, in fact, healthy women with vertex singletons are “allowed” a home birth, and other women are “not allowed.” It’s the same problem as in other places– birthing women are not recognized as having real agency, they’re just “allowed” to do this or that, if they are lucky.
So this judge says that midwives are not competent to attend twins births. In other jurisdictions, judges say that midwives are not competent to attend any birth at all.
“‘Midwives’? What midwives? There are doctors, and there are people practicing medicine without a license.”
Laura’s case represents the pattern that I have seen repeated in many other countries and states. Find the best midwife. The midwife with many years of experience, the midwife with the most skills, the midwife who offers genuine individualized care, the True Midwife. Take her down, in a big, ugly, public way. That will help ensure that other midwives are too scared to offer those services. And so, by cutting off the path to that care, the state channels women into the hospitals, with their ever-rising cesarean rates, with their pitocin injections that you are “not allowed” to refuse.
Like rats in a maze.
I am lucky to have been able to give birth with Laura, while she was licensed and before her persecution began. But supported birth should not be for the lucky. And so I work, to try to do my small part to ensure that every woman has the ability to choose for the support that she, personally, needs to give birth to her babies.”