4 december 2023, 14:00
Holistic? You may have heard the term before. Holistic care stands for ‘all-encompassing’. The pregnant woman’s body and mind participate in the complete picture. So in addition to medical checks, there is also a great focus on a personal approach. Holistic midwives often offer longer consultations and, even if a birth becomes medical, remain present until the baby is born.
Darlene Guda, midwife at De Poort in Amsterdam Zuidoost, opts for a holistic approach. ‘I first look at the pregnant woman and then at the protocol. Who is this woman and what is her cultural background or religion? What does she need to feel good? That’s something different for everyone.’
She sees a growing interest in her way of working. Sometimes women come to her because they have had a bad experience, other times because they want to be in charge of their own stomach during pregnancy. ‘Together we find out where we can find each other, so that I can provide safe care and the pregnant woman feels heard and seen. That often works.’
Also read: Esmee was afraid of childbirth: ‘Until I learned to keep control, even if things don’t go as hoped’
A birth that has always stayed with her is that of a woman with a high BMI who was pregnant with her second. ‘The protocol says: go to the hospital, because there is an increased risk of complications. But she really wanted to give birth at home, in the bath.
We looked with the entire team: can this be done safely? How can we accommodate each other?’ Ultimately, she gave birth the way she wanted in the presence of two midwives and the maternity assistant. “She was grateful that we looked at her as a person.”
Ank de Jonge, professor of Midwifery Science (Amsterdam UMC, University Medical Center Groningen, Academy of Midwifery Amsterdam and Groningen) is not surprised by Guda’s ethos. According to her, every midwife should be holistic. ‘People often think that midwives only focus on medical matters, but that is a misconception. They also look at the psychological and social aspects.’
She understands where that image comes from. Screening has become an increasingly important part of obstetrics in recent years. ‘In many cases, during the introductory meeting, it is already about the NIPT and the possibility of the medical 13 and 20 week ultrasound scans. The focus has shifted to those kinds of things.’
According to the professor, there is basically nothing wrong with that. ‘The fact that we can measure so much also has advantages. But things go wrong when personal attention is suppressed and there is less room for getting to know the pregnant woman and asking how things are going. Unfortunately that happens sometimes.’
Also read: 13 week ultrasound, what exactly does this early ultrasound entail?
Holistic midwives fill that gap by emphasizing personal attention. Some practices mention their holistic approach in their practice name or add it to their job titles. Other healthcare providers, such as the practice where Guda works, choose not to do this, but do explain their vision on their website.
Because this way of working takes more time, an extra contribution is sometimes requested, but that does not always happen. Guda: ‘Our consultations last half an hour, instead of fifteen minutes. We do not charge any extra costs for this, because we want to remain accessible to everyone.’
Taking extra time is what holistic midwives do well, according to De Jonge. ‘The focus on screening sometimes puts this under pressure. While time is one of a midwife’s most important tools.’ The professor has been drawing attention to it for years. She even created a term for it: watchful attendance, in the hope that this ‘invisible care’ will receive more attention.
‘The core of obstetrics is the relationship with the woman. From the support you give her, you monitor clinical progress in a way that is almost invisible. I think women miss that and therefore turn to a holistic midwife, for example.’
Also interesting: The benefits of a doula during pregnancy and childbirth
For Marly from Doorn, that was indeed one of the reasons to switch to a midwife with a broader view of her pregnancy. She lost a lot of blood during the birth of her first child and was terrified of giving birth when she was pregnant with her second.
‘My midwife focused on the risks of my pregnancy, on everything that was not possible because my delivery would be medical anyway, which made me have even less confidence in my body and only became more afraid.’
She visited a pregnancy coach who advised her to contact a holistic midwife. ‘That was a relief. For the first time, someone asked what I wanted. I told her about my preference for a bath birth because I can relax well in warm water, followed by: “but that’s not possible, because I’m medical”.’
Ultimately, Marly became the first pregnant woman with a medical indication to give birth in a bath in the Diakonessenhuis in Utrecht. ‘Many women think that you are a patient if you are at the mercy of the hospital. My holistic midwife pointed out to me that I decide.’ The mindset was ‘what do you need?’ instead of ‘this is what we are going to do’, which helped her regain her confidence.
‘I transformed from patient to director and switched from fear to self-confidence, simply by having a conversation. I did not rebel against the hospital staff, but started working together.’ It gave her a powerful delivery that the doctors were also enthusiastic about. Since then, women with a medical indication regularly give birth clinically in the bath.
Also read: Writing a birth plan: preparing for your birth
The shifting focus on screening and the medical aspect of pregnancy that De Jonge previously mentioned is the reason why midwives are more likely to refer pregnant women to a hospital. Nowadays, 26.7 percent give birth at home, in an outpatient setting or in a birth home.
The rest give birth under the supervision of a clinical midwife (32.4 percent) or a medical professional such as a gynecologist (40.6 percent) in the hospital, according to figures from the Royal Dutch Organization of Midwives (KNOV).
And during medical deliveries, interventions such as a cut or the use of a vacuum pump are more common. These actions are not always done in consultation with the woman giving birth, according to recent research by health scientist Marit van der Pijl (Amsterdam UMC): 41.7 percent of women who received a haircut say that they were not asked to do anything.
An injection of oxytocin, which is given to induce the birth of the placenta, was also given without consent in 47 percent of women. While healthcare providers are required by law to request permission for every medical procedure.
Also read: Was that really necessary? Everything about ‘the cut’ during childbirth
These figures are at odds with the growing need of pregnant women to maintain control during childbirth. And that’s not the only problem. Because once transferred to the hospital, a clinical obstetrician and/or gynecologist takes over from the familiar face of the midwife who assisted the woman all those months.
“Women indicate that they find that annoying,” says De Jonge. ‘At the most exciting moment they have to deal with a new team, while they often feel very vulnerable during childbirth.’ The result may be that they lose their sense of control and surrender themselves to the care providers in the hospital. While that does not match their wishes.
De Jonge hears the need for more continuity of care providers and the focus on the natural process more and more often. ‘Many practices focus on the theme of ‘time’ and personal attention. Drawing up a birth plan, in which the pregnant woman writes down her wishes, is now common practice.’
She also mentions centering pregnancy, pregnancy courses given by her own midwife and the retention of her own midwife during medical deliveries as positive developments that are in line with this. ‘In the past, the basic attitude of healthcare providers was: this is what we have to offer, step into the mill and roll through it. That is slowly changing. The pregnant woman is increasingly being put at the center.
What someone needs varies per person. Shared decision-making is increasingly the norm and this requires a different attitude from both the healthcare provider and the pregnant woman. Good steps are being taken, but such a change takes time. We still have a long way to go.’
Also read: Neeltje tries centering pregnancy: ‘Is it something for me, such a pregnancy wreath?’
More mental guidance
Holistic midwives do not work in all corners of the country and their working method often means they have limited availability. Other options for more mental guidance during pregnancy:
In the centering pregnancy program, which you can follow through various midwifery practices, (medical) checks and all information about pregnancy, childbirth and the postpartum period are combined. Consultations take place in groups, together with women who are due around the same time. Meetings last longer than a standard consultation and are led by two permanent people (often a midwife and another birth expert).
A doula supports pregnant women during their pregnancy, childbirth and afterwards. She supports the woman emotionally and physically, but is not a midwife. So doulas work alongside a midwife.
Pregnancy courses come in all shapes and sizes: from half a day to a six-week course, with or without a partner, focused on yoga/hypnobirthing or practical, in a group or online. Get information from your midwife or search (online) for a course that suits you.
Do you need psychological support without suffering from trauma or serious mental complaints? Contact a pregnancy coach, someone who specializes in supporting you. She can help you find strength and confidence, and provide practical tools.
Anyone who encounters major psychological problems can contact a psychologist. There are practices in various places in the Netherlands that specialize in psychological help for pregnant women.
Depending on your insurer, the above options with supplementary health insurance are often (partially) reimbursed by your health insurer.
2023-12-04 21:54:56
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