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> credited for the Netherlands' low infant mortality rate Wasn't Netherlands birth mortality rate actually higher when compared to neighbor countries because

> credited for the Netherlands' low infant mortality rate Wasn't Netherlands birth mortality rate actually higher when compared to neighbor countries because of the tradition of giving birth at home (which is not dangerous in itself but it means that valuable time is lost in the case the mother has to go to a hospital and the doctors there have to first sync up with the pre-natal nurse)?

SJSque 7y ago
Could be. I'm not an expert (I haven't even looked up the statistics), and I suspect that neither was the person who I heard crediting the kraamzorg system for the low infant mortality rate. I certainly get the impression that giving birth at home is quite 'trendy' here, but my wife and I decided that there was no way that we were going to opt for that. My wife would much rather give birth in a building full of experts and specialised equipment than in the "relaxed, familiar atmosphere" of home.
- markus92 7y ago
  Not really trendy, but more the way it has always been done. Childbirth isn't a disease and shouldn't be treated as such, is the rationale behind it.
  - lotsofpulp 7y ago
    Seems like a silly rationale to me. It’s not like evolution has optimized bodies to be amazing at childbirth. There are many possible complications that modern equipment and expertise can help with that aren’t available at home. You can do the same thing you do at home, with the security of having medical care immediately if things get complicated.
    - daliusd 7y ago
      Despite all modern equipment and expertise „Intrapartum and neonatal mortality was 0.15% for planned home births, 0.18% for planned hospital births“ (source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5465453/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5465453/). Something to think about. Disclaimer: my wife gave birth at home (but not in Netherlands)
      - rimliu 7y ago
        There is nothing to think about. Most serious cases would be treated in hospitals and, alas, sometimes there is nothing medics can do. If you want to think, think about, what those numbers would be if everyone was giving birth at home. https://www.15min.lt/naujiena/aktualu/lietuva/vilniuje-ivyko-nesekmingas-gimdymas-namuose-56-1191524 https://www.15min.lt/naujiena/aktualu/lietuva/vilniuje-ivyko...
        daliusd 7y ago
        What do you think about 60 baby birth deaths in hospitals this year alone in Lithuania? And it is shitty attitude to counter argument science with single really unhappy incident.
        TeMPOraL 7y ago
        You can't just post a random paper and call the case closed. Some points from the paper: - The populations studied were preselected to be low risk, because "Dutch guidelines prescribe a hospital delivery with their midwife-led delivery (no choice of planned home birth)" to women with medium risk levels. So we're not talking home vs. hospital for any women, just for those where the doctors say everything is double-plus super fine with the mother and the baby. The study did adjust for the fact that "either due to self-selection or due to the midwife’s proposal, the healthiest and most affluent women are more likely to undertake a home birth". - From the conclusion, "the benefit of substantially fewer interventions in the planned home group seems to be counterbalanced by substantially increased mortality if intervention occurs". Etc. So what the study says is generally, if you and your doctors are double-plus sure you're low-risk, then you can go for either home or hospital birth; but if an intervention turns out to be needed, you're in big trouble.
        daliusd 7y ago
        I agree that case is not closed, however I was responding to very specific short sighted comment. About your points: Yes, you should understand if you or your relative is in low risk group. Honestly, if possible you should always understand and evaluate risks, whatever you are doing. Problem that humans are really bad with statistics (recommended reading "Thinking, Fast and Slow"). Lastly, you have actually read what I have posted and this is awesome. You can find more scientific sources about positive benefits of home birth. Lastly, I'm not saying that you should do it. My problem is that home births are semi-legal in my country ;-) Shortsighted comment was written by person from my country :-(
    - markus92 7y ago
      You have to keep in mind that there's quite extensive screening on eligibility and low barrier to refer to a hospital, as well as medical care will be available (experienced and well-trained midwifes are present during birth, GP will usually be on stand-by). If there is any major risk of complication, it will be a hospital birth. Living too far from a hospital? You better go there to give birth. Midwife and/or GP doesn't trust it anymore during birth? An ambulance is called and hospital it is (and you'll be there in time, as you live close enough). The distances in The Netherlands are extremely small compared to the USA, it's not like you're giving birth in the middle of nowhere. A more recent trend is that of the 'geboortehuizen' (birth houses), which are literally what the name says: special places just for giving birth. Instead of the clinical atmosphere, it is more like a home but advanced medical care is close-by, as most of them are affiliated with the hospitals. It's seen as a good balance/compromise between the risks of giving birth at home, while still having a more quiet, 'gezellige' atmosphere.
  - rimliu 7y ago
    For many many years (basically up to XX century) the most dangerous thing a woman could do health-wise was to get pregnant. Being pregnant is not a disease, but childbirth is a very high risk.
    - daliusd 7y ago
      Less than 1% of stillbirth and possibility of mother's death is even lower. I'm pretty sure there are things that are more dangerous a woman can do. "Stillbirth rates never exceed 70 per 1,000 total births." (source https://www.cairn-int.info/article-E_POPU_804_0683--late-fetal-mortality-historical-perspect.htm https://www.cairn-int.info/article-E_POPU_804_0683--late-fet...)
  - tomp 7y ago
    it's a disease as much as aging is a disease... extremely risky and often (always in case of aging) leathal.
    - TeMPOraL 7y ago
      Disagree. Aging is a disease as much as cancer is a disease - you'll eventually die of it if nothing else gets you before. The difference between pregnancy and aging is that the former is desirable, the latter is something to get rid of.
sushibowl 7y ago
It's correct that the infant mortality rate in The Netherlands is somewhat higher than neigbouring countries (the sixth highest of European countries), the cause of this is not exactly clear. There was a study in 2010 that drew much media attention, which reached the conclusion that you are talking about. However, the methodology drew some criticism, and followup research (e.g. this https://www.midwiferyjournal.com/article/S0266-6138(15)00214-4/abstract https://www.midwiferyjournal.com/article/S0266-6138(15)00214... from 2015) has contradicted the results. Comparing home and hospital birth can be a difficult problem. Policy in The Netherlands dictates that women who are estimated to have a higher risk of complications must give birth at a hospital. This means that the hospital group's risk profile is inherently different, which is a factor that is difficult to compensate for. It also seems that lower educated women gain more safety from hospital birth, although the exact reasons are unclear. Overall the question is not at all settled at the moment. The research community is also extremely hesitant to communicate with the media out of fear of causing another scare like what happened after the 2010 study. Fact is that home birth is becoming increasingly more rare, down 10 percentage points over the last 10 years.
- tralarpa 7y ago
  Thanks for the link to the 2015 paper. I read the original paper around 2013 and didn't actively look for followup papers in the last years.
- avar 7y ago
  This 2004 paper examining the difference in infant mortality in The Netherlands[1] concludes that it's basically due to immigration, parents being older (father's age is also a factor), and fertility treatments. Some ethnic groups in The Netherlands have 2x higher infant mortality after birth than others, people are older when they're having kids, and having twins (or more) is now 2x as common as in the 1950s due to the availability of fertility treatment. I wonder how up-to-date the results of that older paper are, the other ones discussed here seem to address much narrower questions. 1. https://www.demographic-research.org/volumes/vol11/13/11-13.pdf https://www.demographic-research.org/volumes/vol11/13/11-13....
- stjohnswarts 7y ago

SJSque 7y ago

Could be. I'm not an expert (I haven't even looked up the statistics), and I suspect that neither was the person who I heard crediting the kraamzorg system for the low infant mortality rate. I certainly get the impression that giving birth at home is quite 'trendy' here, but my wife and I decided that there was no way that we were going to opt for that. My wife would much rather give birth in a building full of experts and specialised equipment than in the "relaxed, familiar atmosphere" of home.

markus92 7y ago
Not really trendy, but more the way it has always been done. Childbirth isn't a disease and shouldn't be treated as such, is the rationale behind it.
- lotsofpulp 7y ago
  Seems like a silly rationale to me. It’s not like evolution has optimized bodies to be amazing at childbirth. There are many possible complications that modern equipment and expertise can help with that aren’t available at home. You can do the same thing you do at home, with the security of having medical care immediately if things get complicated.
  - daliusd 7y ago
    Despite all modern equipment and expertise „Intrapartum and neonatal mortality was 0.15% for planned home births, 0.18% for planned hospital births“ (source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5465453/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5465453/). Something to think about. Disclaimer: my wife gave birth at home (but not in Netherlands)
    - rimliu 7y ago
      There is nothing to think about. Most serious cases would be treated in hospitals and, alas, sometimes there is nothing medics can do. If you want to think, think about, what those numbers would be if everyone was giving birth at home. https://www.15min.lt/naujiena/aktualu/lietuva/vilniuje-ivyko-nesekmingas-gimdymas-namuose-56-1191524 https://www.15min.lt/naujiena/aktualu/lietuva/vilniuje-ivyko...
      - daliusd 7y ago
        What do you think about 60 baby birth deaths in hospitals this year alone in Lithuania? And it is shitty attitude to counter argument science with single really unhappy incident.
        TeMPOraL 7y ago
        You can't just post a random paper and call the case closed. Some points from the paper: - The populations studied were preselected to be low risk, because "Dutch guidelines prescribe a hospital delivery with their midwife-led delivery (no choice of planned home birth)" to women with medium risk levels. So we're not talking home vs. hospital for any women, just for those where the doctors say everything is double-plus super fine with the mother and the baby. The study did adjust for the fact that "either due to self-selection or due to the midwife’s proposal, the healthiest and most affluent women are more likely to undertake a home birth". - From the conclusion, "the benefit of substantially fewer interventions in the planned home group seems to be counterbalanced by substantially increased mortality if intervention occurs". Etc. So what the study says is generally, if you and your doctors are double-plus sure you're low-risk, then you can go for either home or hospital birth; but if an intervention turns out to be needed, you're in big trouble.
        daliusd 7y ago
        I agree that case is not closed, however I was responding to very specific short sighted comment. About your points: Yes, you should understand if you or your relative is in low risk group. Honestly, if possible you should always understand and evaluate risks, whatever you are doing. Problem that humans are really bad with statistics (recommended reading "Thinking, Fast and Slow"). Lastly, you have actually read what I have posted and this is awesome. You can find more scientific sources about positive benefits of home birth. Lastly, I'm not saying that you should do it. My problem is that home births are semi-legal in my country ;-) Shortsighted comment was written by person from my country :-(
  - markus92 7y ago
    You have to keep in mind that there's quite extensive screening on eligibility and low barrier to refer to a hospital, as well as medical care will be available (experienced and well-trained midwifes are present during birth, GP will usually be on stand-by). If there is any major risk of complication, it will be a hospital birth. Living too far from a hospital? You better go there to give birth. Midwife and/or GP doesn't trust it anymore during birth? An ambulance is called and hospital it is (and you'll be there in time, as you live close enough). The distances in The Netherlands are extremely small compared to the USA, it's not like you're giving birth in the middle of nowhere. A more recent trend is that of the 'geboortehuizen' (birth houses), which are literally what the name says: special places just for giving birth. Instead of the clinical atmosphere, it is more like a home but advanced medical care is close-by, as most of them are affiliated with the hospitals. It's seen as a good balance/compromise between the risks of giving birth at home, while still having a more quiet, 'gezellige' atmosphere.
- rimliu 7y ago
  For many many years (basically up to XX century) the most dangerous thing a woman could do health-wise was to get pregnant. Being pregnant is not a disease, but childbirth is a very high risk.
  - daliusd 7y ago
    Less than 1% of stillbirth and possibility of mother's death is even lower. I'm pretty sure there are things that are more dangerous a woman can do. "Stillbirth rates never exceed 70 per 1,000 total births." (source https://www.cairn-int.info/article-E_POPU_804_0683--late-fetal-mortality-historical-perspect.htm https://www.cairn-int.info/article-E_POPU_804_0683--late-fet...)
- tomp 7y ago
  it's a disease as much as aging is a disease... extremely risky and often (always in case of aging) leathal.
  - TeMPOraL 7y ago
    Disagree. Aging is a disease as much as cancer is a disease - you'll eventually die of it if nothing else gets you before. The difference between pregnancy and aging is that the former is desirable, the latter is something to get rid of.

sushibowl 7y ago

It's correct that the infant mortality rate in The Netherlands is somewhat higher than neigbouring countries (the sixth highest of European countries), the cause of this is not exactly clear. There was a study in 2010 that drew much media attention, which reached the conclusion that you are talking about. However, the methodology drew some criticism, and followup research (e.g. this https://www.midwiferyjournal.com/article/S0266-6138(15)00214-4/abstract https://www.midwiferyjournal.com/article/S0266-6138(15)00214... from 2015) has contradicted the results. Comparing home and hospital birth can be a difficult problem. Policy in The Netherlands dictates that women who are estimated to have a higher risk of complications must give birth at a hospital. This means that the hospital group's risk profile is inherently different, which is a factor that is difficult to compensate for. It also seems that lower educated women gain more safety from hospital birth, although the exact reasons are unclear. Overall the question is not at all settled at the moment. The research community is also extremely hesitant to communicate with the media out of fear of causing another scare like what happened after the 2010 study. Fact is that home birth is becoming increasingly more rare, down 10 percentage points over the last 10 years.

tralarpa 7y ago
Thanks for the link to the 2015 paper. I read the original paper around 2013 and didn't actively look for followup papers in the last years.
avar 7y ago
This 2004 paper examining the difference in infant mortality in The Netherlands[1] concludes that it's basically due to immigration, parents being older (father's age is also a factor), and fertility treatments. Some ethnic groups in The Netherlands have 2x higher infant mortality after birth than others, people are older when they're having kids, and having twins (or more) is now 2x as common as in the 1950s due to the availability of fertility treatment. I wonder how up-to-date the results of that older paper are, the other ones discussed here seem to address much narrower questions. 1. https://www.demographic-research.org/volumes/vol11/13/11-13.pdf https://www.demographic-research.org/volumes/vol11/13/11-13....
stjohnswarts 7y ago