Dutch model of maternity care Midwifery led service is safe

EDITOR, - We take issue with some of the points raised by Lawrence Mascarenhas and colleagues in their letter on the Dutch model of maternity care led by midwives.1 Their claims are unsubstantiated, their citation of the literature is selective, and their interpretation of the statistics on maternal mortality is imprecise. They claim that women's choice is denied by midwives in the Netherlands. Their anecdote that “one of us is Dutch, and his sister had …” serves to emphasise that fact that they could not find any proper evidence to substantiate that claim.

They then mention the “unacceptably” high perinatal mortality among babies transferred to obstetricians by midwives in the Wormerveer study in the Netherlands, presumably to show that the Dutch system leads to a poor perinatal outcome. The high perinatal mortality of 51.7/1000 was in the subgroup (17.8% of all women) referred to an obstetrician antenatally because the midwife had detected a deviation from the norm, such as preeclampsia, intrauterine growth retardation, and threatened preterm labour. On the other hand, the perinatal mortality …