Symposium | WONDER study: Why Women Want Other or No DElivery caRe

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Overview/Outline:
In the Netherlands, a growing group of pregnant women chooses not to adhere to guidelines as stated in the multidisciplinary indication list for referral from primary to secondary obstetrical care (VIL). On the one hand, there are women with a medical indication for a hospital birth who insist on a homebirth. While on the other hand there are women who, in the absence of medical indication, demand hospital interventions like caesarean delivery (CDMR). There are also cases of women withdrawing from obstetric care altogether (Unassisted Childbirth).  … In the WONDER-study we have explored the motivations of women who choose to birth ‘outside the system’ (e.g. against medical advice and/or guideline/protocol) and the experiences of midwives and obstetricians regarding care for these women. 

Part1:
Why women want other or no delivery care.
Presenter: Esteriek de Miranda (RM, PhD)

Purpose
To explore the motivations of Dutch women who choose to birth ‘outside the system’ (e.g. against medical advice and/or guideline/protocol).

Findings
Four main themes emerged from the interviews: resistance to the biomedical model of birth, conceptualization of risk and safety,  autonomy and intuition. An important reason to go against medical advice and/or guideline/protocol was the unwillingness of midwives and obstetricians to explore the possibility to come to a compromise regarding birth management that still met women’s most important needs in a safe setting.  

Part2:
Unassisted Childbirth in the Netherlands
Presenter: Michelle ten Berge (RM, MSc)
 
Purpose
To explore the motivations of Dutch women for choosing unassisted childbirth (UC) and their beliefs on childbirth in general and in relation to current Dutch maternity care.

Findings
Four main themes were generated: Being imprisoned by protocols; Life perceptions; Let me be and; Being with women. Participants rejected maternity services because they perceive them as being restrictive and negative. Deviant life perceptions influenced their decision-making. Seeing attendants as a distraction and a interference, they perceived birth to be safer without them. However, female company was missed and midwifery attendance would be an option for some, providing that their birth wishes are respected and the relationship incorporates a sense of connection and common ground.

Part3:
Experiences and attitude of Dutch midwives and obstetricians regarding birth ‘outside the system’.
Presenter: Martine Hollander (RM, MD)
 
Purpose
To explore the experiences and attitudes of Dutch midwives and obstetricians regarding care for women who choose to birth ‘outside the system’
… 
Findings
Most midwives and obstetricians are confronted with requests for ‘outside the system’ care. This concerned less protocolized care (e.g. wish for home birth when hospital birth is indicated) as well as more care than indicated (e.g. CDMR). Midwives and obstetricians in the Netherlands are more willing to comply with a request for more care than indicated than to provide less care than indicated. In case of a perceived conflict of interest between a woman’s wish and her baby’s health, a surprising number of both midwives and obstetricians are willing to overrule a competent woman’s refusal, which is not allowed by Dutch law.

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