Elsevier

Midwifery

Volume 29, Issue 1, January 2013, Pages e1-e8
Midwifery

Trends in the medicalisation of childbirth in Flanders and the Netherlands

https://doi.org/10.1016/j.midw.2012.08.010Get rights and content

Abstract

Objective

in this paper we offer new insights about the medicalisation of childbirth by closely examining the trends in obstetric intervention rates in Flanders and the Netherlands and by considering the influence of contextual factors – including the organisation of the medical system, professional guidelines, and cultural ideas – on the way maternity care is delivered.

Design

a comparative study using perinatal statistics from the National Perinatal Databases of the Netherlands and Flanders and historical and qualitative data about the organisation and culture of maternity care in each country.

Setting and participants

in the Netherlands data are gathered from practices of the participating midwives, general practitioners and obstetricians. In Flanders the registration of data takes place in Flemish maternity units and independent midwifery practices.

Measurements and findings

in the Netherlands the home birth rate is still by far the highest in Europe and some interventions (e.g. caesarean section and epidural) are among the lowest. However, some perinatal statistics – such as in the use of epidural analgesia during labour – suggest an increasingly medical approach to birth in the Netherlands. Other trends in the Netherlands include an increasing use of inductions and augmentation in labour, and a decreasing number of births in primary care. The practice of home birth is being challenged by critical discussions in the popular media and ‘scientific’ debates among professionals. In Flanders, there have been some efforts to reduce medicalisation of childbirth, focussed on specific interventions such as induction and episiotomy.

Key conclusions

in recent years the obstetric intervention rates in Belgium and the Netherlands are slowly converging.

Implications for practice

because the lives of women, midwives, and obstetricians (among others) are significantly affected by patterns of medicalisation and de-medicalisation, it is important that we understand the drivers of the medicalising process.

Section snippets

Background

The medicalisation of childbirth has had both desirable and undesirable consequences. The development of medical procedures to respond to pathological problems that arise in pregnancy and birth has had salutary effects for sick babies and mothers: the use of these same procedures when mother and baby are healthy increases costs and creates unnecessary risks to health. In this paper we examine trends in obstetrical interventions in Flanders and the Netherlands – two regions of the world that

Methods

In order to more completely describe the varied levels of medicalisation in the Netherlands and Flanders, we use data from the national perinatal databases of the Netherlands (PRN, Perinatale Registratie Nederland) and Flanders (SPE, Studiecentrum voor Perinatale Epidemiologie). In the Netherlands the registration of data takes place in the practices of the participating midwives and general practitioners (LVR1), and obstetricians (LVR2). A form or an automated system is used for registration.

Within each country

Perinatal statistics from the Netherlands show a small but increasing trend towards more medical interventions in childbirth. Data from 2008 (PRN, 2011) show that in the past several years there has been a small but steady increase (one to two per cent yearly) in the use of epidural analgesia during labour. Other trends in the Netherlands include an increased use of inductions and augmentation in labour (28.8% in 2003 versus 35.0% in 2008), and a decreasing number of births in primary care

Discussion and conclusion

Medicalisation of the birth process is not a new phenomenon. It is something that has taken (and continues to take) place in all western countries. Until recently, however, the Netherlands was known as the country that had resisted that trend. Today, the movement toward medicalised birth – present everywhere else in the modern world – appears to be affecting the wishes and demands of Dutch women (Pavlova et al., 2009, Van der Hulst et al., 2007) and the attitudes of Dutch caregivers (e.g.

Conflict of interest

The authors declare no conflict of interest.

Acknowledgements

This research was funded by and contributes to the EU COST action ISO907: ‘Childbirth Cultures, Concerns, and Consequences’: Creating a dynamic EU framework for optimal maternity care.

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