Medical interventions during childbirth explained (with figures from the Netherlands)
Updated: 6 hours ago
Giving birth is a huge experience. For many women, it feels beautiful and special, but also daunting. Especially when you're pregnant, you quickly hear stories about medical interventions. About induction, epidurals, vacuum extractions, oxytocin, an episiotomy, or cesarean sections. Online, it can sometimes seem like these interventions are standardized, or even performed unnecessarily often. This can be intimidating. It's time to create some peace and clarity.
So what exactly do these procedures entail? Why are they performed? What are the advantages, and what are the potential disadvantages? And how common are they in the Netherlands?
Contents
What is a medical intervention?
A medical procedure isn't a sign that your body isn't functioning properly. It's a tool used when it's safer for you, your baby, or for both of you.
Some interventions are planned in advance. Others arise during labor. In the Netherlands, intervention is generally kept to a minimum as long as both mother and baby are doing well.
What you need at home to give birth there is in the home birth checklist.
There are broadly two kinds of interventions:
Planned interventions: agreed in advance for medical reasons
Situational interventions: decisions that come up during labour
Why do we look at figures from different countries?
Giving birth is so safe in wealthy countries, mainly because there is good access to medical care and interventions when necessary.
That's why we compare the Netherlands with countries that have comparable access to medical care. But to also see how the Netherlands compares to the rest of the world, we also include the global average. This provides a complete picture.
Netherlands
United States
United Kingdom
Other wealthy countries (average)
Global average (where possible)
You'll notice that for some medical procedures, exact percentages aren't given. This is because not everything is tracked consistently everywhere.
Some procedures are often part of labor and are not always recorded separately. Think of breaking the waters, stripping the cervix, or extra monitoring. The precise data measured and recorded also varies by country.
Where reliable figures are available, they are listed here. Where this is not possible, I explain how and why a procedure is used, so you still understand its practical implications. This keeps the overview fair, complete, and easy to follow.
Inducing labor
What is it?
When labor is induced, it is started with medical means, such as a balloon catheter, hormones, or by breaking the membranes.
Why is this done?
Induction is done when it is safer to have the baby than to continue the pregnancy. This happens, for example, with high blood pressure or preeclampsia. It prevents the mother from becoming seriously ill. Induction can also help prevent problems from oxygen or nutritional deficiency. That applies with gestational diabetes or a baby with poor growth.
If the waters have already broken, labor is sometimes induced to prevent infection in the mother or baby. And if a pregnancy lasts too long, the placenta can become less effective. In that case, labor is induced to prevent the baby from experiencing more strain in the womb.
The aim of induction is therefore not to speed up labor, but to protect mother and baby in time.
Possible disadvantages
An induction can sometimes make labor more intense than if it started spontaneously. Contractions can come faster and more powerfully, which can sometimes make labor feel harder. Because of this, some women prefer pain relief. An induction can also take longer, especially in first-time labors, and there's a slightly higher chance that additional interventions will be needed.
That is why a decision is always made: is starting now safer than waiting?
How often is labor induced?
Country / region | Percentage and year |
Netherlands | ± 28% (year unknown) |
United States | ± 30% (year unknown) |
United Kingdom | ± 30 to 35% (year unknown) |
Other wealthy countries (average) | ± 25 to 35% (year unknown) |
Global average | ± 20% (year unknown) |
Explanation
The Netherlands, with approximately 28% inductions, is in the middle bracket. These figures are close to those of the US and the UK. The lower global average is primarily due to limited access to medical care in many countries. Higher rates in wealthy countries reflect the availability of care, not unnecessary interventions.
Artificial rupture of the membranes (ARM)
What is it?
During artificial rupture of the membranes, the midwife or doctor makes a small puncture. This lets the amniotic fluid drain. This can affect the strength and regularity of contractions.
Why is this done?
One reason to break your waters is when labor isn't progressing well. Sometimes contractions slow down or become weaker, causing labor to stall. Breaking your waters can help get labor moving again.
It can also be done to better assess how the baby is responding to contractions. In some situations, it's part of an induction to further support labor.
This only happens if the head has descended properly, so that it can be done safely.
Possible disadvantages
After the waters break, there's no turning back. Labor must then continue. Sometimes the contractions become stronger, but sometimes they don't, requiring additional support, such as oxytocin. There's also a slightly increased risk of infection from that point on, especially if labor takes a long time.
Therefore, this is usually done with a clear reason and explanation in advance.
How often are the membranes artificially ruptured?
Country / region | Percentage and year |
Netherlands (hospital care) | not recorded separately |
United States | Comparable |
United Kingdom | Comparable |
Other wealthy countries | Comparable |
Global average | Varies |
Explanation
This procedure is more common in countries with good access to maternity care. Because artificial rupture of the membranes is often part of a larger care process, it is not recorded separately. There is therefore no reliable percentage for the Netherlands.
Epidural analgesia
What is it?
Epidural pain relief is administered through a thin tube in the lower back. This significantly reduces the pain signals of contractions, while the woman usually remains conscious.
Why is this done?
One reason to choose an epidural is when the pain or fatigue becomes too great. This can happen, for example, during a prolonged labor, or if you get little rest between contractions.
Sometimes an epidural also helps the body relax. If you're very tense due to pain, relaxation can actually help labor progress more smoothly.
When the pain remains severe for too long, it can cause exhaustion. This makes it harder to cooperate during labor. In some situations, extreme tension or fatigue can hinder labor progress.
Possible disadvantages
An epidural can affect your movement and sensation during pushing. This can sometimes make the final stages take a little longer, and additional assistance, such as a vacuum, is more often needed. Side effects can also occur, such as low blood pressure, itching, or sometimes headaches. Therefore, extra close monitoring is usually required, for example, with blood pressure measurements and a heart monitor.
How often is an epidural used?
Country / region | Percentage and year |
Netherlands | ± 25 to 30% (year unknown, last firm figure 23% in 2020) |
United States | ± 70 to 75% of vaginal births (year unknown) |
United Kingdom | 57% had some form of anaesthesia or analgesia (2024-25) |
Other wealthy countries (average) | ± 35 to 55% (year unknown) |
Global average | Lower and variable |
Explanation
The Netherlands uses epidurals less frequently than the US and the UK. This is due to its strong primary care system and the increased availability of other forms of pain relief. At the same time, epidurals are available whenever a woman needs them.
Continuous CTG monitoring (heart monitoring)
What is it?
With continuous CTG monitoring, the baby's heart rate and contractions are continuously measured using bands around the abdomen.
Why is this done?
One reason to use continuous CTG is when there is an increased risk during labor. This could be the case with an induction or an epidural. It also applies if there are medical concerns for the mother or baby.
With a continuous CTG, the baby's heart rate and contraction pattern are constantly monitored. This allows for rapid detection of changes in the baby's condition.
Without this monitoring in a high-risk situation, signs can be picked up later. That is true for stress or oxygen deficiency in the baby. This can make it harder to act in time if something truly changes.
Possible disadvantages
With continuous monitoring, you'll be connected to equipment more often. This can restrict your freedom of movement and make labor feel less spontaneous. Sometimes the CTG gives inconclusive signals. That can lead to extra checks or interventions, even though the baby turns out to be doing well.
That is why, in cases of low risk, occasional listening is often chosen instead of continuous measurement.
Explanation
Internationally comparable percentages are not available because countries record this differently.
Vacuum or forceps (assisted delivery)
What is it?
During an assisted delivery, the baby is assisted during pushing with a vacuum cup or, less commonly, forceps. This is only done when the baby is already deep in the pelvis.
Why is this done?
An instrumental delivery is used when the baby needs to be born more quickly. Or when pushing is no longer possible because of exhaustion.
Sometimes the pushing stage takes too long, or the baby's heart rate shows signs of distress. This usually means the baby is struggling to cope with the contractions. If this stress lasts too long, there may be a temporary lack of oxygen.
Without action in such a situation, the baby may remain under pressure for longer. The mother may also become too exhausted to keep pushing.
Possible disadvantages
The baby may temporarily experience swelling or bruising on their head. The mother is more likely to experience tears or an incision. Therefore, recovery may take a little longer.
How often does an instrumental delivery occur?
Country / region | Percentage and year |
Netherlands | 6.0% (2024) |
United States | Lower |
United Kingdom | ± 7 to 10% (year unknown) |
Europe average | ± 7 to 8% (year unknown) |
Explanation
With 6.0% in 2024, the Netherlands is at or below the European average. The rate of assisted deliveries here has been falling for years. Sometimes the baby is already low in the birth canal. An assisted delivery is then a safe and suitable alternative to abdominal surgery.
In countries like the United States, cesarean sections are more often chosen in similar situations. Consequently, the percentage of assisted deliveries is lower there. This difference doesn't mean that care is less safe, but that countries make different choices.
Cesarean section
What is it?
A cesarean section is a surgical procedure performed inside the abdomen. Sometimes this is planned in advance. Sometimes the need arises during labor. In such cases, it's called an emergency cesarean.
Why is this done?
Planned cesarean section
This could be the case if the baby is in a breech position. Or if the placenta lies in front of the cervix. Other medical reasons can also make pushing unsafe.
If you were to give birth vaginally in such a situation, it could lead to serious complications. Think of dangerous blood loss for the mother, or a baby who could become stuck or in distress.
Emergency cesarean section
For example, labor may stop progressing, or the baby may show signs of stress.
In such a situation, a cesarean section is performed to ensure prompt action. If left untreated, the baby could experience prolonged oxygen deprivation. The mother could also become exhausted or develop complications, such as blood loss or infection.
Possible disadvantages
A cesarean section is an abdominal operation and requires more recovery time than a vaginal birth. There is a higher risk of pain, infection, or scarring. A cesarean section can also affect subsequent pregnancies.
What you put ready for your own recovery is in the postpartum recovery kit.
How often is a cesarean section performed?
Country / region | Percentage and year |
Netherlands | 18.3% (2024) |
United States | 32.4% (2024) |
United Kingdom | 45% in England (2024-25) |
Other wealthy countries | 25 to 35% (year unknown) |
Some countries worldwide | Cyprus is the highest in Europe at 53.1% (2015-2019) |
Explanation
The Netherlands is relatively conservative in its use of cesarean sections. This doesn't mean they are avoided or abstained from, but rather that they are used deliberately. A cesarean section is a major abdominal operation. It asks more recovery time and carries more medical risks than a vaginal birth.
That is why in the Netherlands it is first examined whether a vaginal birth is safely possible.
Episiotomy (cut)
What is it?
An episiotomy involves making a small incision in the area between the vagina and anus to temporarily create more space.
Why is this done?
An episiotomy is performed when it is considered more protective than tearing. Or when the baby needs to be delivered quickly. Sometimes there's not enough time to continue pushing calmly, for example, if the baby is showing signs of stress.
If no cut is made in such a situation, there may be an increased risk of a deep or uncontrolled tear.
Possible disadvantages
An incision can be painful, and healing can take longer than with a small, natural tear. Some women experience prolonged pain or tension in the scar area.
That is why a cut is not done as standard, but only when it is more protective than waiting.
How often is an episiotomy performed?
Country / region | Percentage and year |
Netherlands | 16% of all births (2020) |
United States | ± 12 to 15% (year unknown) |
United Kingdom | ± 15 to 20% (year unknown) |
International (historical) | 30 to 60% (year unknown) |
International (now) | Decreasing |
Explanation
In the Netherlands, the episiotomy is used selectively and not as standard. This is in line with current insights into maternity care. At an assisted vaginal delivery it is far more common. Between 2000 and 2010, 84.5% of women who had an assisted delivery received an episiotomy.
Stripping the membranes
What is it?
During stripping, the healthcare provider uses a finger to loosen the membranes from the uterine wall through the cervix.
Why is this done?
Stripping is done when the pregnancy is nearing term. The aim is a better chance of a spontaneous birth, without inducing labor straight away.
If stripping is not done, labor may take longer to start on its own. With a pregnancy that lasts too long, the placenta can gradually become less effective. Amniotic fluid can also decrease, and the risk of the baby experiencing stress during labor may increase slightly. Furthermore, the baby often continues to grow, which can make labor more difficult.
This means a medical induction may still be necessary later. If labor becomes more difficult afterward, the chance of extra interventions is sometimes greater. Think of drugs to strengthen contractions, an assisted delivery, or in some cases, a cesarean section.
Possible disadvantages
Stripping can be uncomfortable or painful, especially if your cervix is still closed. After stripping, you may experience some bleeding or cramping, and sometimes irregular contractions that stop. There's also a small chance of your waters breaking, which means labor will need to be induced sooner.
Explanation
Stripping is widely used, but not registered separately.
Oxytocin via IV (to induce or strengthen contractions)
What is it?
Oxytocin is a hormone that causes contractions. Sometimes the body doesn't produce enough of it, or the contractions subside. In such cases, oxytocin can be administered intravenously to induce or intensify contractions.
Why is this done?
One reason to use an oxytocin infusion is when labor isn't progressing well. Sometimes contractions become too weak or irregular, causing dilation to stop or labor to last too long.
If help isn't provided in such a situation, labor can become increasingly prolonged. The mother can then become exhausted. The baby may also have a harder time. He or she endures contractions for longer and recovers less well between them. In some cases, this can lead to stress or a temporary decrease in oxygen.
Possible disadvantages
Contractions can become faster and more intense than the body would normally produce. This can make labor intense and increase the chance of pain relief. Continuous monitoring is often necessary, which limits freedom of movement.
Therefore, the dosage is carefully built up and closely monitored.
How often does this happen?
There are no reliable individual percentages for this. Oxytocin is often used as part of an induction. It is also combined with other interventions, such as rupturing the membranes or continuous monitoring.
Explanation
Because oxytocin is so often used in conjunction with other interventions, it usually doesn't appear as a separate statistic. The higher use in affluent countries speaks primarily to the availability of medical support, not to unnecessary interventions.
Oxytocin after birth (protection against blood loss)
What is it?
After the baby is born, the mother is often given oxytocin by injection to help the uterus contract properly.
Why is this done?
Oxytocin is administered after birth to stimulate uterine contractions. This helps release the placenta and firmly compress the blood vessels in the uterus.
This reduces the risk of heavy bleeding. Heavy bleeding after delivery is also called postpartum haemorrhage. This can make a mother dizzy or very weak very quickly. In severe cases, extra treatment or a blood transfusion is needed.
Possible disadvantages
Side effects are usually mild. Some women experience brief nausea, chills, headaches, or a hot/sweaty feeling. Serious side effects are rare.
Because the risk of heavy bleeding (postpartum haemorrhage) far outweighs these disadvantages, oxytocin is often given as a preventive measure.
Oxytocin is also the hormone responsible for the let-down reflex: the moment when milk starts flowing. That's why some parents wonder if synthetic oxytocin can affect breastfeeding after birth.
Research doesn't provide a clear answer here. Many studies show that it usually has no noticeable effect on initiating breastfeeding. There are also studies that carefully suggest something else. Oxytocin around the time of birth may be linked to slightly more breastfeeding problems in some women. Or to a shorter breastfeeding duration.
At the same time, this is difficult to compare properly. Oxytocin is often given after a longer or more difficult labor. Those circumstances themselves can influence how breastfeeding starts.
How often does this happen?
This happens in a large proportion of hospital births, as well as in home births. It's rarely considered an "intervention," but medically it is.
Explanation
This care is preventative. The goal is not to intervene, but rather to prevent complications. Therefore, it is considered good standard care worldwide.
Internal monitoring (scalp electrode)
What is it?
Internal monitoring involves placing a small electrode on the baby's head to measure the heart rate more accurately.
Why is this done?
Sometimes the external heart monitor isn't clear enough, for example, if the reading keeps dropping out. In that case, a scalp electrode can be used to monitor the baby's heartbeat more accurately. This helps to better understand how the baby is doing during labor, especially when extra monitoring is important.
Possible disadvantages
Insertion may be uncomfortable. A small wound will develop on the baby's head, which usually heals quickly.
How often does this happen?
This is only done in specific situations and is not used by default.
Explanation
Internal monitoring is intended to provide better information, not to automatically increase intervention. It is used when doing so provides additional security.
Frequently asked questions
Can I decide in advance whether I want interventions?
You can always discuss your wishes in a birth plan. Even so, a birth stays partly unpredictable. Sometimes the situation changes during the birth, and you look together at what is safest at that moment.
Does one intervention make more interventions more likely?
Sometimes, but not always. Some interventions are linked, for example an induction that can lead to stronger contractions and therefore more often to pain relief. At the same time, interventions sometimes prevent bigger medical problems.
Is an epidural bad for my baby?
Epidural pain relief is widely used around the world and is generally safe. The baby is monitored extra closely while it is in place. Some births take a little longer, but serious risks are rare.
Can I still give birth naturally if medical help is needed?
Yes. Many interventions support the natural birth process. Even with pain relief, an induction or extra monitoring, you can have a positive and involved birth experience.
How do I know whether an intervention is really needed?
Care providers weigh the benefits and possible downsides for your specific situation each time. You may always ask questions, ask for an explanation and decide together where that is possible.
Do medical interventions affect recovery after birth?
Some interventions can make recovery take a little longer, such as a cesarean section or an assisted delivery. At the same time they are used to prevent bigger complications. Good aftercare helps recovery, whatever your birth was like.
Calm and trust around giving birth
Giving birth is always a big deal. And no matter how your labor goes (spontaneous or with extra support), you don't have to go it alone. In the Netherlands, you are surrounded by healthcare providers who support you every day. Midwives, gynecologists, maternity nurses and nurses, with a lot of experience. They share one goal: good care for you and your baby.
What is special about maternity care here is the balance. As natural as possible, with as little intervention as needed. And with all medical help close by.
Ultimately, it's not about a perfect birth on paper, but about a birth where you can feel supported. Where you can gradually trust your body, the people around you, and the safety net that's there if extra help is needed.
On how a birth that went differently can feel afterwards, read your birth is not a character test.
Love,
Bobby
Sources
Written by Bobby, maternity nurse at Bobby Kraamzorg. Last updated: September 2026.
