The shift from home to institutional childbirth: a comparative study of the United Kingdom and The Netherlands.

The British system of childbirth with a very low rate of home childbirth is compared to that in The Netherlands, a country with a relatively high percentage of home deliveries. The analysis explores three possible explanations: the structure of the health professions in both countries, the structure of their health systems, and the use of scientific information in guiding policy decisions on birth place. Differences in the professional status and training programs of midwives between The Netherlands and the United Kingdom affected the distribution of home versus institutional deliveries in the two countries. Reimbursement schemes in The Netherlands have been important in maintaining a high percentage of births at home in this country. In the United Kingdom centralized planning and the influence of medical thinking played major roles in accelerating the shift from home to hospital deliveries in the National Health Service.