Abstract

Community midwives in the Netherlands have a greater degree of autonomy in relation to the medical profession than do midwives in most countries. They are independent practitioners having full responsibility for providing continuous care for healthy women who are pregnant, and for conducting ante-natal assessments to ensure that those women with pathology are referred to hospital specialists. The midwives attend over 40% of all deliveries, more than half of which take place in the mother's home (the remainder being short-stay hospital births). General Practitioners (GPs) are precluded by health-insurance regulations from receiving payment for maternity care, except in rural areas where no community midwife is available. Midwives are assisted in home deliveries by maternity home helps, who also take on household tasks for mothers during the first few days. This service is used by more than two-thirds of all mothers, since it is also available after a hospital birth. Its availability helps to explain the continuing high percentage of home confinements in the Netherlands (36%). The Dutch system, giving midwives a high degree of responsibility and of financial independence, can give rise to tensions between midwives and obstetricians, but limits unnecessary medicalisation of childbirth.