America: Land of the Weak?

I took a small break from blogging because I was busy delivering a baby and mastering the basics of keeping said baby alive. Success all around, so here I am back on the horse. My baby break gave me some fascinating material for my blogging comeback: so many more women in America take pain medication during labor than their Dutch counterparts. And what’s the deal with all those caesareans here? Are women in the States incredibly dependent on doctors compared to their Dutch equivalents who have natural home births non-stop? Does this mean American ladies are weak and Dutch women are tough? Time for some research so this Dutch Mommy won’t offend her American friends.

First, let’s get into some dry numbers to make you understand where I’m coming from. More than three out of five women in the U.S. take an epidural when they give birth compared to merely one out of five Dutch women. Caesareans are performed in 33 percent of all deliveries in America, in the Netherlands it’s only half of that. Around 16 percent of Dutch women even choose not to deal with a hospital at all and give birth at home – which is just as safe as in a hospital – compared to less than 2 percent in America where experts recommend against home births because of higher death rates. Honestly, this data did initially make me wonder if Americans just have much lower pain thresholds than their Dutch counterparts. And question if deliveries just always transpire smoothly and without any complications in the Netherlands. But then my husband told me I was probably sleep-deprived and my postnatal hormones were likely going nuts. So, after some nights of proper sleep and once those raging hormones subsided, I did some further investigation into why Holland and America seem to be on both ends of the spectrum. Turns out, it’s a matter of midwives and medicalization.

Not all midwives are created equal
On the midwife matter: in the world’s flattest country they’re considered queens (and occasionally kings) but in America they’re inferior commoners in some expert’s opinions. In the Netherlands a gynecologist only comes into the pregnancy and birth equation when there are serious risks or complications. In America it’s the other way around: most pregnant women see an OB/GYN and only a small group of about 10 percent chooses to deal with midwives. Intelligible choices for habitants of both countries since Dutch midwives are highly trained academic professionals but in the good old U.S. of A. that’s not always the case. A qualified group of academically schooled Certified Nurse Midwives (C.N.M.’s) suffers in comparison to the less well-trained Certified Professional Midwives (C.P.M.’s). Shockingly, the majority of American midwife assisted births are attended by the lesser skilled group who receive an inadequate education through correspondence courses and training with another – dare I say – unequipped C.P.M. They, surprisingly, don’t feel they need more training because they are ‘experts in normal birth’. Amy Tuteur, a former clinical instructor in obstetrics-gynecology at Harvard Medical School and author of Push Back: Guilt in the Age of Natural Parenting, hits the bull’s eye with her comment in the New York Times: “That makes as much sense as a meteorologist being an expert in sunny weather. Anyone from a taxi driver to a 12-year-old sibling can handle (and has handled) an uncomplicated birth. The only reason to have a trained attendant is to prevent, diagnose and manage complications, the very things that C.P.M.’s never have to learn to do.” This revelation makes me understand why OB/GYN’s have a better rep in the U.S. than midwives and are the way forwards for most women. Since gynecologists are quicker in enforcing interventions like spinal anesthesia and caesareans than midwives and the largest group of pregnant American women relies on them, we now have a more grounded explanation for the discrepancy in birth statistics.

Anyone from a taxi driver to a 12-year-old sibling can handle an uncomplicated birth

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I assume medical professionals on either side of the pond pursue only one goal: a healthy baby and mother

Different cultures, different expectations
Some personal field research clarified that it’s not just doctors that augment intervention rates in the Land of the Not-So-Weak-After-All. During my pregnancy, I noticed it’s far more common for my fellow American preggos to opt for numbing drugs beforehand. In Holland it’s kind of the norm that you try to get through the whole labor shebang without pain medication and only scream bloody murder for it ‘when really needed’. At the same time, my American/Australian/English expat friends in Amsterdam share a consensus that Dutch doctors are fairly pointless since “they’ll only prescribe proper pain medication or antibiotics when you’re actually dying”. I suppose an ‘attitude of perseverance’ is embedded quite deeply into Dutch culture which might make us reach for pain medication less quickly than Americans, for whom medication is a much greater part of everyday life. So I wasn’t that surprised when I arrived at the hospital to find my anesthetist ready and waiting with a cocktail of sedation. But he was surprised when the nurse told him I did not want to try his mix just yet. Fast forward six hours to me screaming bloody murder for the epidural, when it was really needed. Let’s call it the perfect form of Dutch-American integration.

Dutch doctors are fairly pointless according to my expat friends

Risk is what you make of it
The medicalization of American births also becomes clear when you compare my story with that of my Dutch friend Leonie’s. Don’t worry, I’ll spare you the more gruesome details. Four days before my due date my water broke but the contractions stubbornly wouldn’t come. This means, according to both American and Dutch doctors, that risk of infection starts to soar. However, there are different opinions on how to handle these risks. My OB/GYN here ran a Fetal Non-Stress Test (NST) in his practice to assure the health of me and my baby, and advised me to come to the hospital 12 hours after my water broke. Had this pregnancy occurred in the Netherlands however, the midwife would have let me wait at least 24 hours. They wait longer in Holland anyway. In the US they’ll normally let you go past your due date by between 6 and 10 days before they induce, rather than 14 days that are protocol in the flat countries. And the Dutchies are also willing to be even more flexible, as my friend Leonie found out. She wanted to wait longer than recommended, to which her midwife agreed as long as she was being monitored by the hospital every other day. Leonie delivered her son after 42 weeks and 3 days of pregnancy. Which is a Week and a Half of No Induction that probably would have driven an American gynecologist mad. Why wait with induction anyway, you ask? Because it gives you more violent contractions and you miss out on the opiates nature usually provides during labor because your induced body annoyingly switches those hormones off. Overall, not great. Which is why I screamed bloody murder for that epidural.

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I owe it to the doctors of Mount Sinai that I now have an 8-month-old crawling around my house

Babies first
So, doctors in the U.S. tend to intervene sooner than their Dutch colleagues who have a more wait-and-see approach. What’s wrong with that? Any medical intervention comes with risk, so avoiding that risk is always the more desirable option. Even ‘skeptical OB’ Amy Tuteur, who’s not shy of attacking the natural childbirth movement, agrees C-section rates in America are way too high. The Netherlands are studied by doctors worldwide as an example because ‘they know how to have safe unmedicated home births’, alongside with Canada by the way. Even though I praise my epidural because it helped me get through tough times, I still don’t really understand why you would opt for it without even having felt a single contraction. Hey, I am not judging (every woman is entitled to do as she wants), I am only Dutch. Ultimately though, I assume that medical professionals on either side of the pond pursue only one goal: a healthy baby and mother. And that’s all that really matters. My preference was to have an unmedicated natural birth but you don’t give a sh*t about that if it starts messing with the health of your baby. I would have ended up with a C-section in either country, I’d just been part of a smaller statistic in Holland, but who cares? I owe it to the doctors of Mount Sinai Hospital that I now have an 8-month-old crawling around my house, getting into all kinds of mischief. No taxi driver or 12-year-old sibling would have been able to handle his birth. Which is why I end my post with a compulsory request: America, for God’s sake, train ALL your midwives properly, please.

Read more about the differences between the U.S. and Holland:

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