Tuesday, March 23, 2010

Netherlands' epidural use is on the rise

Epidural during childbirth on the increase

A growing number of Dutch women are opting to have epidural anaesthesia during childbirth, according to a survey of teaching hospitals by free daily newspaper Spits

With epidural pain relief, an anaesthetic is injected via a catheter into the spine. Since January 2009 all hospitals have been obliged to make the procedure available 24 hours a day – a new development in Dutch obstetrics.

The Netherlands has one of the highest rates of home births in the developed world. Around a third of all births take place at home. A similar proportion of pregnant women plan to give birth at home if all goes well, but on the basis of the midwife’s risk assessment they transfer to hospital during labour.

The Dutch home birth system isn’t the product of any recent move towards de-medicalisation and natural birth – it’s simply that many Dutch women still give birth at home the way their grandmothers did. Dutch midwives don’t use nitrous oxide as a painkiller as is the practice in some countries, so home births take place without pain relief.

The Dutch midwives association argues in favour of seeing childbirth as a natural process rather than a medical condition. It points out that home births result in a much lower rate of unnecessary medical intervention, which is safer for both mother and child. However, in recent years the Dutch system has increasingly come under attack. Critics claim it is old-fashioned, and women are being denied proper access to pain relief.

In 2008, the teaching hospital in Maastricht reported that 25 per cent of women opted to have an epidural. A year later this figure has risen to more than 30 percent. Despite the increasing numbers, the Dutch epidural rate has a long way to go before it matches that of many other countries. In some hospitals in the United States, for example, as many as 85 percent of women in labour opt for an epidural.

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