Dutch obstetric care: home or hospital, midwife or gynaecologist?

The Dutch obstetric system is traditionally characterized by extensive primary health services, supported by more specialized care. Midwives and GPs are responsible for normal deliveries, obstetricians for the deliveries considered high risk. Home deliveries are fairly common. Over the last decade this relatively positive approach to reproduction has threatened to give place to methods that seem to oppose the goals of health promotion. The percentage of home deliveries has declined from 57% in 1970 to 35% in 1985. The distinction between normal and pathological pregnancies and deliveries has become more blurred. A growing number of women with a normal pregnancy are giving birth in hospital. In sparsely populated regions, primary health care is inadequate, but this explains only part of this development. As far as parents-to-be have a choice, little is known about their considerations and about the role of different professional groups in how they choose. Between the various medical professions, competition arises about the division of tasks and about the hierarchical relation to one another. The role of obstetricians has become more important, GPs are losing ground, while midwives retain their share in practising obstetric care. Rivalry between different professional groups has been stimulated by the decline in the birth rate and the increase in the number of professionals. The increased number of pregnant women whose pregnancy and delivery is defined as 'pathological' reflects the continuing process of medicalization. Different developments may explain this process: the increase in hospital births, progress in medical science, the older age of women having their first baby.(ABSTRACT TRUNCATED AT 250 WORDS)