The Dutch obstetrical system: vanguard of the future in maternity care.

The German poet Heinrich Heine is reported to have said, “When the world comes to an end, I shall go to Holland, for everything there happens fi fty years later.” For some, this Dutch “quaintness” explains the unusual system of obstetric care found in the Netherlands, a system where nearly one-third of births occur at home and where midwives have a degree of professional independence unrivaled by midwives in any other country.1 Heine’s observation about the Netherlands suggests that the unique Dutch way of birth is a vestige from a bygone era—a credible conclusion if you believe that humans are helpless in the face of technology. But the stubborn persistence of midwifery and home birth in the Netherlands, in spite of the declaration of medical professionals elsewhere that midwifeattended birth at home is a dangerous anachronism, forces us to conclude that Dutch obstetrics can be the vanguard of the future. The singularity of the Dutch maternity care system has made it a model for all those who seek to slow or reverse the march toward the medicalization of birth found in the developed world (Van Teijlingen et al. 2004). For birth activists, the Netherlands has become the destination for inspiration and for instruction on how to reorganize birth in their home countries. The uniqueness of the system, coupled with the desire of short-term visitors to fi nd what they are looking for, has resulted in mischaracterizations of the Dutch way of birth. For example, Mehl-Madrona and Mehl-Madrona (1993: 1) claimedthat “over 70% of births [in the Netherlands] are still attended by midwives.” In fact, in the early 1990s midwives accompanied about half of all births in the Netherlands (see Table 1.1). As far back as 1910, the fi rst year a breakdown by caregiver is available, midwives in the Chapter 1