Medical interventions during childbirth explained (with figures from the Netherlands)
- Desiree Bobby
- 3 days ago
- 13 min read
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, epidurals, 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?
In this article we look at medical interventions during childbirth: what they mean, when they are used, and how often they occur in the Netherlands.
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.
In this article we compare with:
🇳🇱 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, such as breaking the waters, stripping the cervix, or extra monitoring, are often part of labor and are not always recorded separately. 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.
First of all, what is a medical procedure anyway?
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.
In this article we discuss, among other things:
induction of labor
waters break
epidural injection
CTG heart monitoring
vacuum or pliers
cesarean section
cut
strip
oxytocin via IV
oxytocin after birth
manual removal of placenta
scalp electrode
Inducing labor
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 is done, for example, in cases of high blood pressure or preeclampsia, to prevent the mother from becoming seriously ill. Induction can also help prevent problems due to oxygen or nutritional deficiency in cases of 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 labour, 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 |
🇳🇱 Netherlands | ± 28% |
🇺🇸 United States | ± 30% |
🇬🇧 United Kingdom | ± 30–35% |
🌍 Other wealthy countries (average) | ± 25–35% |
🌎 Global average | ± 20% |
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)
During artificial rupture of the membranes, the midwife or doctor deliberately makes a small puncture in the membranes to allow the amniotic fluid to 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 |
🇳🇱 Netherlands (hospital care) | ± 40–60% |
🇺🇸 United States | Comparable |
🇬🇧 United Kingdom | Comparable |
🌍 Other prosperous countries | Comparable |
🌎 Global average | Changing |
Explanation
This procedure is more common in countries with good access to maternity care. Because ARM is often part of a larger care process, it is not always recorded separately. The percentage primarily reflects active childbirth management.
Epidural analgesia (spinal tap)
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 |
🇳🇱 Netherlands | ± 25–30% |
🇺🇸 United States | ± 70–75% |
🇬🇧 United Kingdom | ± 30–60% |
🌍 Other wealthy countries (average) | ± 35–55% |
🌎 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)
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, for example, with an induction, an epidural, or 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.
If this monitoring isn't used in a high-risk situation, it can sometimes take longer for signs of stress or oxygen deficiency to be detected 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 provides inconclusive signals, which can lead to additional checks or interventions, even though the baby ultimately appears 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 (artificial delivery)
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?
One reason for an instrumental delivery is when the baby needs to be born more quickly, or when pushing is no longer possible due to exhaustion.
Sometimes the expulsion takes too long, or the baby's heartbeat shows signs of labor. 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.
If no action is taken in such a situation, the baby may remain under pressure for longer or the mother may become too exhausted to continue 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 |
🇳🇱 Netherlands | ± 9% |
🇺🇸 United States | Lower |
🇬🇧 United Kingdom | ± 7–10% |
🌍 Europe average | ± 7–8% |
Explanation
The Netherlands uses vacuum extractions or forceps slightly more often than some other countries. This is partly because relatively fewer cesarean sections are performed here. In situations where the baby is already deep in the birth canal, an assisted delivery can be a safe and appropriate 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.
Caesarean section (section)
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, for example, if the baby is in a breech position, if the placenta is in front of the cervix, or if there are other medical reasons why pushing is 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.
How often is a cesarean section performed?
Country / region | Percentage |
🇳🇱 Netherlands | 16–17% |
🇺🇸 United States | ± 32% |
🇬🇧 United Kingdom | ± 26–29% |
🌍 Other prosperous countries | 25–35% |
🌎 Some countries worldwide | > 50% |
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, requiring more recovery time for the mother and carrying 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)
An episiotomy involves making a small incision in the area between the vagina and anus to temporarily create more space.
Why is this done?
One reason to perform an episiotomy is when it's 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 do you get a haircut?
Country / region | Percentage |
🇳🇱 Netherlands (first line) | ± 10–13% |
🇺🇸 United States | ± 12–15% |
🇬🇧 United Kingdom | ± 15–20% |
🌍 International (historical) | 30–60% |
🌍 International (now) | Descending |
Explanation
In the Netherlands, the episiotomy is used selectively and not as standard. This is in line with current insights into maternity care.
Strips
During stripping, the healthcare provider uses a finger to loosen the membranes from the uterine wall through the cervix.
Why is this done?
One reason for stripping is when the pregnancy is nearing term and one wants to increase the chance of a spontaneous birth without having to induce labor immediately.
If the placenta is not removed, labor may be delayed even longer. 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. And if labor becomes more difficult afterward, there's sometimes a greater chance of additional interventions, such as labor inducers , 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)
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 experience more difficulty, as he or she must endure contractions for longer and may recover less effectively between contractions. 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 or in combination 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)
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 cause a mother to quickly become dizzy or very weak, and in severe cases, additional treatment or a blood transfusion may be necessary.
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 bleeding) 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 tentatively suggest that oxytocin around the time of delivery may be associated with slightly more breastfeeding problems or a shorter breastfeeding duration in some women.
At the same time, this is difficult to compare properly, because oxytocin is often given after a longer or more difficult labor, and it is precisely those circumstances that 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.
Manual removal of the placenta
If the placenta does not detach on its own, a doctor or midwife can remove it manually.
Why is this done?
Sometimes the placenta doesn't detach naturally after birth. If it remains attached, it can lead to heavy bleeding or infection. In that case, manual removal of the placenta is necessary to protect the mother's health and safety.
Possible disadvantages:
This is a major procedure usually performed under anesthesia. Recovery may be somewhat sensitive, and there is an increased risk of bleeding or infection.
Because it is rare, it is only done when absolutely necessary for the mother's safety.
How often does this happen?
This happens rarely. It concerns a small minority of births.
Explanation:
Because it's rare and often unexpected, this intervention isn't always specifically identified in the figures. However, it's good to know it exists and why it's sometimes necessary.
Internal monitoring (skull electrode)
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.
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're surrounded by healthcare providers who support you every day: midwives, gynecologists, maternity nurses, and nurses with extensive experience and one shared goal: providing excellent care for you and your baby.
What's unique about maternity care here is that they often opt for the most natural approach possible, with minimal intervention, but with all medical assistance readily available if needed. This combination makes the Netherlands one of the safest places in the world to give birth, for both mothers and babies.
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.
Love,
Bobby
