The obstetric system

The Dutch obstetric system is very different from that in most other western countries. This is because in other countries, pregnancy and childbirth are much less regarded as natural processes and much more as possible risks to mother and child. In these countries, pregnant women are guided by gynaecologists. Obstetricians practically always work in a hospital, under the supervision of gynaecologist.

Pregnancy and birth: an illness or a natural process?
In the Netherlands, pregnancy and birth are regarded as normal processes that can be guided in first line care: by obstetricians and general practitioners active as obstetricians. Gynaecologists and obstetricians actively work together, so that in the event of complications specialist care can be offered in the hospital.

Specialist in the hospitals are continuously prepared for possible complications. They in first instance regard their clients as patients. Experience shows that this often means that, in the hospital, the natural process of pregnancy and delivery is intervened in sooner. For example, in countries where childbirth takes place in hospital, more pregnancies are induced than in the Netherlands. The number of artificial deliveries (vacuum extractions and forceps deliveries) tend to be higher. These types of interventions mean an additional load to mother and child.

Obstetricians are trained not to unnecessarily drive pregnancies and deliveries into the medical atmosphere. The same applies to clinical obstetricians. They approach a woman who has been referred because of a complication (e.g. amniotic fluid containing meconium) not as an illness; insofar possible, they regard her and her pregnancy as normal. And rightly so: the progress of her pregnancy is, in principal, not different, she only requires a higher level of monitoring.

The advantages of the Dutch system
The Dutch system has a number of advantages:

• If there are no risks, women themselves choose where they want to deliver: at home or in hospital
• Pregnancy and delivery are regarded as normal events, where possible
• More expensive second line care is used only if so required

Freedom of choice as to where to deliver
In the Netherlands, a woman can choose to deliver in various places:

• At home or in a maternity hotel; this is possible if it concerns a normal delivery
• As an outpatient in hospital (straight home after the delivery)
• As an inpatient in hospital (the woman remains in hospital for more than 24 hours on the basis of medical indications)

An outpatient delivery is normally guided by a first line obstetrician.