Could 'low risk' pregnancies in the Netherlands be more dangerous for newborn babies?

November 02, 2010

While the risk remains low the authors are surprised at the results and say "a critical evaluation of the obstetrical care system in the Netherlands is urgently required."

Despite the high level of medical care in the Netherlands, the perinatal mortality rate (death of fetus or new born baby) is one of the highest in Europe, says the study.

The management of childbirth delivery in the Netherlands is divided into two independent systems - midwife-led care for low risk pregnancies and obstetrician-led care for high-risk pregnancies. This differs to all other obstetric care systems in the industrial world. Home birth in the low risk group is popular and 22% of this group deliver their babies this way.

The authors, led by Dr Annemieke Evers from the University Medical Center in Utrecht, investigated whether the obstetric care system in the Netherlands contributes to the high perinatal mortality rate.

Evers and colleagues assessed the data of 37,735 births from a region in the middle of the Netherlands covering 13% of the Dutch population. The overall perinatal death rate in the study group was 2.62 per 1,000 babies delivered but this risk more than doubles for infants of low risk pregnant women.

The authors were also concerned to note that this risk more than triples for babies of women who were referred during labour by a midwife to an obstetrician.

The results also show that there was no difference in the admission rate of babies born to low and high risk women to neonatal intensive care units (NICU).

Dr Evers believes this study puts "severe question marks by the supposed effectiveness of the Dutch obstetrical system that is based on risk selection and obstetrical care at two levels." She says "the Dutch system of risk selection in relation to perinatal death at term is not as effective as once thought ... this implies as well that the high perinatal death in the Netherlands compared to other European countries is among other factors possibly caused by the obstetrical care system itself."

In an accompanying editorial, Mr Derek Tuffnell, Consultant Obstetrician at the Bradford Royal Infirmary, believes women at low risk of complications should be given a choice of having their baby at home or in a midwifery unit.

While Tuffnell acknowledges that Evers' study suggests that the higher rate of perinatal mortality in the Netherlands may be "because women were inappropriately booked for labour care under a midwife," he adds that "risk assessment is an inexact science" and that no birth is without risk.

He says "low risk does not equal no risk, and high risk women who are away from consultant care are a particular risk."

Mr Tuffnell concludes that the study is welcome but it can only provide estimates. He argues that the debate about how to manage low risk and high risk pregnancies will continue and that "women will have to make individual choices."


Related Death Articles from Brightsurf:

Recommendations to improve consensus of determining brain death, death by neurologic criteria
International professional societies developed recommendations for minimum clinical standards to determine brain death/death by neurologic criteria in adults and children to improve the consistency of these criteria within and among countries.

Silicones may lead to cell death
Silicone molecules from breast implants can initiate processes in human cells that lead to cell death.

Sleep, death and ... the gut?
A new study finds a causal link between sleep deprivation and death.

Risk of death from stroke falls by 24%
Thousands more patients each year are surviving strokes, as the risk of death and disability after a stroke fell significantly between 2000 and 2015, according to analysis by Guy's and St Thomas' researchers.

Cells control their dance of death
La Trobe University researchers have revealed for the first time how white blood cells control the final moments of their death, helping their own removal from the human body.

Predicting frailty, disability and death
In a study led by investigators from Brigham and Women's Hospital, researchers analyzed patterns of movement among elderly study participants and found that irregular, spontaneous fluctuations could predict a person's risk of frailty, disability and death years later.

One in 10 people have 'near-death' experiences, according to new study
The new findings were presented at the 5th European Academy of Neurology (EAN) Congress.

Jobs vs. death toll: Calculating corporate death penalties
What misdeeds warrant corporate death penalties? A new study explores two case studies focused on industries that kill more people than they employ.

New role for death molecule
To unravel programmed cell death pathways, investigators examine a molecule deemed unimportant, and find new function.

Death near the shoreline, not life on land
Our understanding of when the very first animals started living on land is helped by identifying trace fossils--the tracks and trails left by ancient animals--in sedimentary rocks that were deposited on the continents.

Read More: Death News and Death Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to