Woman power in Birth Street

An interview with midwives in the Journal for Midwives (Tijdschrift voor Verloskundigen) November 2004, by Birgitte Tebbe

The hub of the Amsterdam Birth Centre is the obstetric practice. It is surrounded by a maternity care centre, a clinic, a lactation consultancy, a day care centre, a course centre, the Birth Shop, a masseuse and a homeopathic practice. 1000 registrations a year and eight midwives isn’t exactly small. But a small-scale approach is a priority in the organisation. Because the needs of the midwives also count: to keep their work enjoyable they each do a maximum of 90 births a year.


What is the history of the Birth Centre?
Beatrijs: ‘I started the obstetric practice on the Genestetstraat with Agaath Schoon in 1984. In 1985 Astrid Limburg came to work with us as a locum. With her I developed the concept of the Birth Centre, inspired by what we had seen in Indonesia. There midwives did births at their own homes. Next to the house they have a building for the prenatal care and the delivery, and the women stay there in the period after the birth. The clinic is outside. The scales for weighing the babies hang on a tree. And in the same place they also discuss contraception. At the time I thought: this is it! The midwife is the hub and you do everything else around her.’

Bea: ‘The Birth Centre started in 1991 with the obstetric practice, a small maternity care centre, a small shop and a limited number of classes. As time went on, the centre added an ultrasound practice, an obstetric surgery and a children’s café. The maternity care centre grew, as did the shop and the number of courses. Our own ultrasound practice became the practice for all first-line care providers and moved to its own location around the corner from us. Meanwhile the children’s café closed, it’s now the day care centre ‘Meesenstijn’. The homeopath, shiatsu therapist, acupuncturist and masseuse joined us and now there’s also a lactation consultant.”
Beatrijs: “The basis of the Birth Centre is a golden square: the obstetric practice, the maternity care centre, the course centre and the clinic. The rest are trimmings, to give extra service and convenience to the parents-to-be and new parents.’

The obstetric practice has a central role at the Birth Centre. How do you maintain this?
Bea: ‘The midwives provide the supply of clients for the entire centre and are responsible for the most important moment: the birth. They have regular contact with the other departments. One of the midwives – Beatrijs – is the director. She keeps watch over the central role of the obstetric practice. But actually it’s the client who is central. We have one common aim: everything revolves around the client and we are her partner.’

How do the midwives work?
Bea: ‘There are eight midwives working in the obstetric practice in different smaller teams. Up to 32 weeks, a pregnant woman only sees two midwives. Only after that does she get to know the other midwives in her team. Ultimately we’d like to work principally in teams of two.’
Beatrijs: ‘At the moment we’re doing an experiment whereby a number of midwives have their own private clients. For us the main thing is service and the way the client experiences it. A trip to the Birth Street should be a pleasure for everyone.’
Bea: ‘At the surgeries we pay a lot of attention to the women’s personal issues and problems. It’s easy for us to refer them on to the courses and other facilities.’

Beatrijs: ‘In principle everyone starts the birth at home. Only when they are in labour do the women decide what they want to do: stay at home, or go to the hospital. During the pregnancy the couples come to an information evening, which gets everyone looking forward to the birth. We work a lot with water. Nearly everyone takes a bath or a long shower during dilation. Since recently we’ve been able to call in an acupuncturist at this stage too, to strengthen the contractions, for example, or for pain relief. As far as possible we go with the woman if she has to go into hospital.’

What is your role as director, Beatrijs?
Beatrijs: ‘I’m an ideas person and an initiator. As director I make sure the underlying vision is expressed. I keep an overview and make sure everyone stays at full strength. Sometimes I have to troubleshoot. Deputy director Netje Reezigt is my right hand woman: she takes care of the practical management and makes sure the books are in order together with the book keeper. I still work one day a week as a midwife too, by the way. And I also write books and give lectures.’

What is your vision of obstetric care?
Mary-Elliz: ‘We try to make women able to give birth under their own strength.’
Beatrijs: ‘It doesn’t matter if it turns out to be a caesarean or an assisted delivery. As long as women make use of their full potential. This has advantages in the period after the birth. You also need a lot of strength and self-confidence to bring up a child lovingly. Women should help each other to arouse that primal strength. Helping at a birth is about liberation at a physical level. Autonomy is not only in your head, but also in your body.’
Bea ‘The function of the Birth Centre is to help tap into that “woman power”’.

As a midwife, what’s it like to work in a ‘birth street’ with so many different businesses?
Bea: ‘Very inspiring. You can feel that the obstetric practice is the hub. The common aim is motivating. There’s never a dull moment!’

Taking the maternity care centre as an example, how does it function within the whole?
Bea: ‘We work together organisationally. That is to say, each department has its own professional responsibilities. The maternity assistant and the midwife are friends who complement each other. They have to be able to trust each other completely and fall back on each other. The maternity care centre has an important function within the Birth Centre. It now employs 38 maternity assistants. By working together you get to know one another well and you build up a bond. You notice it during the births.’

You do three or sometimes two visits per new baby. Does that work all right? Don’t the clients find it too little?
Mary-Elliz: ‘We do a visit on the second, fourth and seventh day. The visits are long and thorough. Apart from that we can totally rely on the maternity assistants. This working relationship makes the Birth Centre so unique.’
Bea: ‘We’re always very approachable. If necessary we go more often, we don’t make it a problem. The maternity assistants know us well and don’t wait too long to call us in.’

How do you deal with women’s disappointment if the birth hasn’t gone normally and an intervention has been necessary?
Mary-Elliz: ‘If the preparation is good, the chance of disappointment is smaller. It’s about having a good experience, not about achieving a ‘natural’ birth at all costs. Intervention, assisted delivery, is just unavoidable sometimes. We’re lucky to be living in the twenty-first century. The chances of abnormalities and death have never been so small. Everyone is and remains responsible for her own experience, of course, however a birth goes.’
Beatrijs: ‘We do what we can. If the pain is too severe and it becomes too much, there’s the possibility of an epidural, or an injection to take the sharp edges off the pain. We try to help women to get through the experience unscathed in every respect. Because of this there’s often a glorious ending!’

How busy are the midwives in your practice?
Beatrijs: ‘Because we try as much as possible to stay with the woman during the birth, also if she goes into hospital, the midwives can’t do more than about ninety births each a year. We think seventy would actually be better. That’s our ambition. Then you can offer more calm, attention and quality. Midwives salaries are and remain inadequate. They’re still appallingly low if you look at the number of working hours, the night work and the huge responsibility. It’s a real women’s profession, and so it’s underpaid.’

What are the future plans for the Birth Centre?
Beatrijs: ‘Hopefully the street is soon going to be pedestrianised. Then we’re going to redesign it together with the people in the neighbourhood. Perhaps with a water pump, a grass area in the middle, to emphasise the idea of a meeting place. Because it’s there on the benches that the real exchange of information between women happens!
Apart from that we’re developing fertility and motherhood surgeries. And… the Birth House is hopefully on the way. We want to create a place where it’s great to give birth. With nice birthing pools and an open fire. Giving birth at home with the midwife. A really cosy place where you can provide modern pain relief. The Birth House is a step closer to a home birth, instead of the other way round. When you’ve given birth the first time at the birth house, the second time you’ll do it at home in your own bed.
We’re also dreaming about a spa and wellness centre for mothers-to-be and young mothers, with baths, sauna and massage. A place for women to get rid of their stress and treat themselves. Because tension and stress gets in the way of a carefree pregnancy and is the main cause of physical complaints and disorders during pregnancy and in the first year after the birth. All the treatment should be aimed at slowing down and relaxing. The element of water plays an important role. That’s why a heated swimming pool is an essential part of the Spa alongside the sauna, Turkish bath, floatation tank, whirlpool and rest room. Pregnant women and mothers need to be massaged!’