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Infant Mortality Investigated

By Clogsandtulips @clogsandtulips
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This post was originally published in the March 2011 issue of The Holland Times. The Holland Times is a newspaper that reports Dutch news in English for the expat community. A monthly publication, The Holland Times can be picked up for free at various locations throughout Amsterdam, The Hague, and Rotterdam, or you can pay for a subscription and have it delivered to your home. For more information, check out the website.

Infant mortality investigated One out of every 100 babies dies shortly after birth in the Netherlands. As experts attempt to identify causes for this high infant mortality rate, TIFFANY JANSEN investigates the popular notion that home births are the cause.

It’s been all over the news worldwide: The Netherlands has one of the highest infant mortality rates in Europe.

According to the Central Bureau of Statistics (CBS), one out of every 100 babies born in the Netherlands dies not long after birth.

Not exactly comforting news for those thinking about giving birth in the Netherlands. But in a country as developed as the Netherlands, why are the numbers so high? To answer this, the media turned to the one thing the Netherlands offers that no other western country still does - the option of home birth.

But is home birth actually the culprit?

According to a study in Utrecht, the answer is yes. Researchers found that home births were two times more likely to end in death than hospital births.

Interestingly, a large number of deaths occur en route from home to hospital when complications arise during a home birth. To avoid this, the Wadden Islands of Terschelling and Vlieland – where the nearest hospital is further than the recommended 45 minutes – have eliminated home births altogether.

Advocates for home birth argue that it is just as safe as hospital birth. A 2009 study by a group of maternal and child health specialists in the Netherlands found that home births also lead to lower chances of C-section and less use of forceps or vacuums, as well as an increased chance of the mother being satisfied with her experience.

Such satisfaction would have been a blessing for expat Amanda van Mulligen, who wanted both of her sons to be born at home but ended up with hospital deliveries instead. Van Mulligen says her first time was “not an enjoyable experience.”

“By the time the contractions changed to second-stage, there was no staff available as the maternity unit was running at full capacity and the staff was busy with other births,” she says. “My husband had to go and find someone [and] I had to hold off the urge to push for 30 minutes. There was talk of a vacuum pump being used if things didn't improve. It was stressful for all involved.”

Midwife Truus Gale from Childbirth Class Gale attests to the wealth of options open to women who choose to give birth at home.

“Midwives allow women to have the birth they want to have; in their own home, in the bath, on the birthing chair. They are trained to help women through the difficult time of dilation, breathe with them, massage, and suggest other positions.”

In actuality, only 24 percent of births in the Netherlands occur at home. But, about half of all planned home births end up being referred to the hospital due to complications. All this makes it seem unlikely that home birth can be the sole cause of the issue.

So if home births are not entirely responsible, what other factors contribute?

Poor pre-conception and pre-natal health, for one. More women in the Netherlands continue to smoke and consume alcohol throughout their pregnancy than in most other countries.

Furthermore, medical screenings to conclude if a pregnancy is high or low risk are typically conducted by gynecologists. Because midwives handle all pregnancies in the Netherlands unless complications arise, these screenings are not done as recommended. As a result, roughly 25 percent of at-risk pregnancies go completely undetected.

As midwifery professor Eric Steeger from the Erasmus University Medical Center sees it, “In the Netherlands we have to get rid of the idea that [childbirth] will probably be fine.”

“Out of 100 infant deaths during a home birth, some 80 percent are premature, display growth retardation or have serious birth defects,” says doula Jennifer Walker. These factors could have been caught earlier and labeled as high-risk had proper screenings been done.

Other risk factors include age, ethnicity, and multiple births. In the Netherlands, the majority of mothers fall between the ages of 30 and 35, which puts them at a higher risk. CBS also reports that non-western immigrants are 50 percent more susceptible to infant death. In his research in Rotterdam, Steegers also found a strong correlation between disadvantaged districts and high infant mortality.

Walker urges mindfulness when looking at the statistics. Calculating infant mortality, the death of unborn infants, and death during delivery or the first week after delivery are all included.

“Holland [also] includes late abortion figures. Other countries exclude that data,” she says. Because infant euthanasia is legal in Holland, Dutch pediatricians are more likely to suggest the option of aborting or euthanising the baby if it has no quality of life, deaths that are also included in the total figures.

Figures should be kept in perspective when compared to other European countries' infant mortality rates, says Gale. “In Belgium they didn’t count the poor states, in Germany they didn’t count in East- Germany, and in other countries they didn’t count abortions or mortality before 28 weeks.”

One statistic we can count is that infant mortality has been on a steady decline in the Netherlands since 2007. And as the country becomes more aware of the issue and how to combat it, those numbers should only continue to decrease.

Pick up the Aptil issue of The Holland Times for Tiffany's article on Queen's Day

Photo: paparutzi, Flickr


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