Strictly speaking, maternity services are counted as primary services, meaning that they must be provided up front without cost. However, the costs can be chased up afterwards and there have been unpleasant stories of NHS debt collectors chasing impoverished new mothers for the costs of their maternity care. And some frankly scary stories of women being put off scheduling much needed cesarians because they know they will have to shoulder the cost later. Some women have even been known to turn up at A & E to give birth, having fallen through the cracks altogether until right at the point of giving birth.

Now that is the sort of thing that plays havoc with your maternal mortality rates, as well as, y’know, resulting in dead babies.

Women will always have a widwife with them (if they so wish) but a maternity unit may well be full and a pregnant women near or in labour sent to another unit, probably further away. Shortages mean that homebirths can be difficult to arrange.

Women with low risk pregnancies delivering at home or in community midwife lead units do not have obstetrics cover in the UK and any complications will require ambulance transfer. You won’t have a doctor present at the birth of a normal delivery.

In terms of reducing maternal mortality, the conifidential enquiry reports: “Despite the limitations, the assessors classified 64 % of Direct deaths and 40% of Indirect deaths as shown in Table 1.11 as having some degree of substandard care. Table 1.12 gives the degree of substandard care compared to the previous two Reports. The overall rate of sub-standard care for women dying of Direct causes has fallen a little compared to the 67% reported for the last triennium whilst there has been a very small rise in the rate for Indirect deaths. By contrast, only about 10 % of both Coincidental and Late deaths had elements of sub-standard care. The major concerns about the care provided for these groups of women were a lack of liaison and communication between the health and social services in providing support for vulnerable young girls and a lack of multidisciplinary or co-ordinated care.”

Incidentally, comparisons between the UK and other countries should be borne with at least some caveats since many women avoided or had difficulty accessing maternity care: “Many of the women who died found it difficult to seek, or to maintain contact with, maternity and/or other health services. The many possible reasons for this have been discussed throughout this Chapter and the main characteristics of the women who found it diffi cult to attend are summarised in Table 1.27.” where these factors are ethnicity, language skills, employment, domestic abuse, immigration status, and social services/child protection issues.

I suspect it may also be a feature of being young and inexperienced (20 years old). The obvious solution is to make sure that no-one does the job who hasn’t got several years of experience of doing it before.

I think that the real ‘danger’ of having a kraamzorg is that they might do things like making sure that the father was able to change a nappy within forty-eight hours of the child being born. That – rather than concerns about jackboots – is what I suspect might be really fueling resistance to the idea in some people’s minds…

‘In your head’, shurely? There’s also a risk that your public garbage collection might turn into a surveillance system that rifles through the trash for samizdat. This means you should store all of your home refuse in your bedroom.

Further: maternity leave is the slavery of liberal fascism.

There are a few issues here: the need to ensure safe childbirth without overly medicalising the process; the provision of midwives; and some provision to make sure support’s there in the first few weeks.

Nah—I think they usually wear sensible shoes:

http://www.hslda.org/hs/state/nc/200310030.asp
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2002/06/10/BA118333.DTL

But sometimes they do bring a couple guys in boots along just in case:

http://www.hslda.org/hs/state/tx/200712041.asp
http://www.gopusa.com/ohio/news/thewalshes0303p.shtml

I don’t mean to make too much of this—and obviously parents have no right to abuse their children behind closed doors. But it’s not implausible that a universal postnatal home nursing program might morph into this kind of social work with the nurses/social workers tasked with assessing the fitness of the parents and making recommendations for continuing supervision. In the U.S. anyway—perhaps that’s not a danger elsewhere.

Certainly this is a minor issue in comparison to the kind of no-knock paramilitary SWAT raids that Radley Balko has been documenting, but there are similarities: agents of the state feeling like they have a free hand in dealing with certain kinds of people—poor and minority people, in case of the SWAT-teams raids, and home-schooling evangelicals in the social work cases (whereas I know with near certainty that neither would ever happen in my upper-middle class neighborhood).

There are plently of women without such support for whom this could be essential help. But when the funding for the post-birth midwife visits and health visitor visits have been slashed consistently, you have to wonder about the thinking behind these proposals. Sounds like announcement-itis to me – after all, it would be much less dramatic if they’d said “we’ll put the money back where it used to be”, wouldn’t it?

On the kraamzorg and ‘free housework’ thing – I thought there were now fairly strict rules in Holland about exactly what you could ask your nurse to do? They’re not going to iron the father’s shirts, for example?

That’s because intrusiveness is inbred to the Dutch. This is the country that leaves its curtains open at night, after all.

Haven’t had first hand experience with the kraamzorg as such, but I know my mother was very glad to have them after the birth of my youngest brother and sister.

It is optional, and you can also opt to have it for less than the maximum hours (in my time the max was 8 days and 8 hours per day). Don’t forget that ‘kraamzorg’ is also given for homebirth. In the Netherlands you have to pay a few hundred euro if you want to deliver in hospital and there are no medical reasons for it. So often the woman gives birth at home and the nurse will arrive at or just after the birth.

The diary is mainly a chart with the temp and pulse of the mother and the baby and with the number of wet nappies (when you breastfeed the easiest way to make sure that the baby gets enough milk is to count those).

Monitoring visitors means that she will provide something to drink and eat (traditionally a rusk with aniseed sprinkles) and will ask them politely to leave after half an hour or so – unless the mother specifically requests them to stay longer. It’s more to defend the mother than to keep track of who visits.

I agree with the latter sentence – the maternity nurses enable women to take sufficient rest and make the arrival of a newborn less stressful but they are not going to change mortality rates (at least, I can’t see how that would be so).

Could you expand on the issue of not having enough midwives—is that a serious issue? You’re not telling me that there are women in the UK who have to give birth without a midwife or a qualified doctor being present, I hope?