Until September 1, pregnant women could opt to induce birth from week 41 onwards. If they wished, the delivery was artificially triggered in the hospital.
But that is now different in Twente. The midwives have been given more responsibility there and are allowed to break their membranes at home, hoping to induce labor spontaneously. “This is a regional agreement, and not therefore not a national policy”, says Carin Kleiweg, office manager of the Royal Dutch Organization of Midwives.
Other types of pilots are underway in other parts of the country. For example, midwives in Amsterdam are allowed to place a balloon at home in the 41st week: another way to induce labor and to avoid having to initiate labor in hospital.
The new guideline in Twente only applies to pregnancies with a low risk. For women with diabetes, high blood pressure or pre-eclampsia, there is a medical indication. This also applies if a baby has stunted growth. “Safety is paramount,” says primary care midwife Myrthe Bijsterbosch to EditieNL.
“It is really not that we want to promote home births, but we want to give women more freedom of choice. We want the client’s experience to be better. We sometimes hear from women that they see too many new faces in the hospital during the delivery, while they actually enjoy having one trusted person there, “says Bijsterbosch.
The expectation is that the new agreements in this region will lead to more births with a dedicated midwife (at home or outpatient).
That is also the wish of Merlyn Bult from Enschede, who is now 35 weeks pregnant. “My own midwife feels familiar to me. I have discussed my birth plan extensively with her. Someone like that accompanies me at the most vulnerable moment of my life. I don’t want that with someone I don’t know.”
She is very pleased that the midwives in Twente have been given more responsibilities during the delivery. “They know you and can estimate what you need. I think it ensures that you can get through the delivery more relaxed.”
In 2005, 23 percent of women delivered at home. In 2018, that was only fourteen percent, according to figures from Perined. So this is a decrease of nine percent in thirteen years.
According to Jan van Lith, chairman of the Dutch Association for Obstetrics and Gynecology, there is nothing wrong with giving birth at home, but it must be chosen for the right reasons. “In the Netherlands we tend to say that medical intervention is bad. As if you fail, and they do terrible things in the hospital. That’s the biggest nonsense.”
According to Van Lith, that should not be the reason for giving birth at home. “It is fantastic that it can be done at home, but we must be clear that it is about the best care for mother and child. That is the starting point. Not that it happens at home.”
In addition, he sees another obstacle. “In the hospital, work is done neatly in one file. This is how the doctor and maternity nurse see what the gynecologist is doing and vice versa. That is the right way: this is how the care connects seamlessly. But this is not always properly arranged for home births. “