Friday, July 13, 2012

Human Rights in Childbirth: Panel 5

Panel 5:
Perinatal Mortality in the Netherlands: 
Facts, Myths, and Policy


The morning began with a keynote speech by Raymond de Vries about having a baby in the Netherlands. I missed the first half (I slept in on purpose--I was exhausted). I listened to the rest of his presentation in the balcony while I pumped. I had been away from Inga for 48 hours at that point and was probably a full cup size larger, even after pumping a few times.

Panel 5 opened with Anna Myrte Korteweg, a mother who wrote a book about birth choices in Holland after her traumatic first birth. Her book is called Vrije Geboorte (Freedom of Birth), and she blogs here. She had planned a home birth but had to transfer to a hospital during labor. 
Elselijn Kingma, a philosopher and bioethicist from the UK and the Netherlands, addressed the relationhsip between science and policy. How we interpret the numbers from scientific studies isn't a given and is highly subject to variation. Our narrow focuson perinatal mortality shows that we don't equally value all members of society (i.e., we tend to gloss over mothers who are subjected to massive harms in the process of hospital births). Where people feel safe isn't objective or fact-based, ut determined by both policy and rhetoric.

Manon Benders, a pediatrician and neonatologist, presented her experiences with perinatal mortality. She works in a NICU and sees struggling babies on a daily basis. This, of course, influences her perspective on place of birth. I found a disconnect between her message--which was quite well-intentioned--and her audience. She called for what she saw as an innovative way to meet the needs of mothers who wanted to birth at home, while providing immediate access to medical and surgical care for mothers or babies who need it: a "multi-disciplinary birth center." I don't think she realized that this is exactly what a hospital is--a place where all providers are in one location--but that that very system fails to meet the needs of all pregnant women. I sensed some frustration among the audience that she didn't really get the main messages of the conference. 

Next, Ank de Jonge, first author of the large Dutch home birth study, spoke about perinatal mortality in the Netherlands. We should avoid jumping to hasty conclusions, she advised. She also noted that the intense focus on Dutch perinatal mortality is not mirrored in others coutnries with similarly high numbers. For example, Denmark has a higher term PNMR than the Netherlands, yet they don't question their maternity care system. However, because the Dutch maternity care system is different from most of Europe's, it is home birth that gets questioned and too often blamed.

Mariel Croon, a Dutch midwife and journalist, examined how money and the media in influencing attitudes towards home birth and midwifery in the Netherlands. The media has a very powerful role in this country, and midwives have been forced into a defensive role due to media reporting of recent studies. She recommended that midwives should use the media strategically and should take an offensive role the conversations about maternity care, much as Dutch obstetricians have already done. She also called for more women's voices in these debates, which are too often overwhelmed by professionals.


  1. The mother was Anna Murte Korteweg, het book: Vrije Geboorte (Freedom of birth) her blog with more info:

  2. Sorry I meant Anna Myrte Korteweg

  3. We have to acknowledge that medicalization of labour and birth is being continually recreated by midwives as well as medical practitioners (Downe, 2008).

    The prove of this acknowledgement was noticed during the HRIC conference in the Hague, last month, by careful listening to some Dutch midwives and all doctors at the platform.
    Tine Oudshoorn, midwife business consultant NL.

  4. Rixa, I'm so grateful that you have continued your report on the conference! Your accounts of the take-aways from each panelist are very helpful.

    One thing to note about your observation that Dr. Benders didn't seem to fit her message into the subject of the conference, is that she, like some of the other doctors at the conference, didn't come for the whole thing. She just came for her panel. So she was there less to learn than to tell her own story, which she did well with those slides of brain scans and babies in the NICU: "This is what I see."

  5. My 2 cents...

    Why would Dr. Benders or anyone else be expected to adjust their presentation to fit the message of the conference? I thought most presenters were on topic and relevant.

    Plus, I thought of the conference was a place where diverse opinions came to present, which was seen most in Panels 5 and 6. I would have found it off-putting if Hermine had told me that I could present but would need to tailor it to fit a message or mission. It negates the entire reason for bringing together people for a discussion.

  6. True, Jill. The whole point was to bring together a wide (and differing) range of perspectives and opinions. At the same time, the point was also for people to listen to each others' perspectives and engage them, not just show up and read their own script, but have a conversation.

  7. Yes, agreed Jill--and I hope I wasn't implying that I felt Dr. Benders should have altered her message. But I think I was correct in my comment on the audiences' vibes that I felt from her talk! I wish I could have learned more about what she was proposing--she seemed really excited about this idea of a "multidisciplinary birth center" but didn't (maybe because of a lack of time) distinguish it from our current hospital maternity care. She really spoke as if she were proposing something new and innovative, though.


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