The Netherlands Home Birth Study

I don’t have the full study, but have read the abstract and excerpts from the abstract that were posted on multiple birth-related blogs, but haven’t written about it yet. Perhaps if I get the full study I will, but I figure everybody has already read about it anyway. Anyway, if you haven’t heard about it, there was a new study released that looked at low-risk Dutch women who gave birth at home vs. the hospital, and found no real differences in maternal and neonatal morbidity and mortality. Oh, and the study was a measly 500,000+ women, so I’m sure it will be pronounced too small by certain anti-homebirth people. <sarcasm>

Anyway, one of my facebook “friends” is a midwife in Australia (her blog is here), and apparently Australia is already in the middle of a birth crisis as far as homebirth midwives are concerned — talking about taking away privileges, making women go to OBs or FPs, etc. — if you are interested about this subject, you can find a wealth of information in the several most recent posts. Of course the release of this new study prompted a facebook posting, along the all-too-familiar lines of waiting for the [insert medical body here] to declare that the Dutch study does not apply and cannot be extrapolated to [insert country here]. In her case, it was Australia, but I fully expect something State-side too, and am only surprised I haven’t heard about it yet (not that I’m on Google alerts for it or anything, but still).

There were a couple of comments I liked — one woman said that if the Dutch results “don’t apply” elsewhere because of poor home-to-hospital transfers (particularly in the case of an emergency), then that indicates a problem with the obstetric service, and particularly ambulance care, rather than with the midwives themselves. I agree. The problem is, it’s easier to kick out midwives and shut down home birth than to improve American medical care so that the tiny percentage of mothers or babies who might actually need emergency care during a planned home birth get the needed care. Add to that, that somehow I doubt that when Dutch women transfer from a planned home birth to the hospital (whether due to an emergency, or the more common reasons of wanting medical pain relief or perhaps needing or wanting Pitocin/Syntocin to augment labor) that they are given a healthy dose of ATTITUDE for having had the audacity to plan a home birth from the hospital staff, which is one major concern among home-birthing women here in the States.

But the comment that I found simply fantastic was this:

Isn’t it amazing how birth outcomes from the Netherlands/UK/North America cannot be extrapolated to the Australian population…. yet homebirth outcomes in a war-torn third world country amongst a malnourished infibulated population can?!

Yes, yes, YES!! If you have talked “home birth” with very many medical professionals (especially OBs) for very long, you’ve probably heard the above argument. The typical response from them is along the lines of, “Well, women used to die from home birth,” or “Look at maternal and neonatal mortality in countries like Sierra Leone where most women have home births!” [Oh, and “infibulated” means that the labia have been sewn shut — typically in girlhood, to prevent them from having sex; in some areas, one of the gifts the groom receives is a special ceremonial knife with which he cuts open her labia — it proves that his bride is indeed a virgin. Not that that can cause any problem in the “birth” department. <sarcasm with rolling eyes>]

So, while this study may not be perfect (I don’t know if it has any weaknesses, but which study is perfect?), the results from it are far more easily extrapolated to fit other Western countries than are bare maternal/neonatal mortality from third world countries. So, the next time somebody tries to argue with you that home birth isn’t safe because of what happens in sub-Saharan Africa [or that the difference in mortality and morbidity in these countries vs. modern countries is mostly or completely due to god-like OBs], while also saying that this Dutch study cannot apply to other countries, you now have a quick retort.🙂

2 Responses

  1. Very good point. I read over and over again about Sierra Leone, but any study on homebirth safety is given a “can’t extrapolate to here”. I have heard rumours of the homebirth crisis going on in Australia, and I hope it turns out well for them. It’s so sad that midwives should have to fight for their rights in the 21st century. Will people ever give it a rest?

  2. There’s another Australian midwife’s blog, http://www.sydneymidwife.com.au, which I have been following that is a good read. I hope women like this, who think with their heads and follow evidence based practice, are not stamped out. Midwives need to be able to have attending rights, just like drs, so they can practice privately and still float between hospitals as lead carer. Women in Aus. are still being induced/augmented with Cytotec and prostins for VBAC, are forced to birth by the clock, and are sold interventions in the name of safety. So what gives? How can any community of doctors, in any country, continually practice bad medicine, without fully divulging the risks of drugs and procedures, then turn around and point the finger at midwives and undrugged birth as being more dangerous? These lower case drs. are ignoring the benefits of evidence based birth, and refusing to set aside practices which greatly increase the chance of death and disability for mothers and babies, and call it safe? It seems pretty obvious that the “I’m a Doctor, I know best, now quit asking questions, shut up, and do what I say!” attitude is at play, and that people are buying it. I wonder how many healthy people will be adversely effected before the general public is shaken awake?

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