Births conducted exclusively by midwives should be increasingly possible in the canton of Zurich. The Spital Zollikerberg takes a special approach.
A “House of Birth” is to be built at the hospital in Zollikerberg.
The pandemic brought about a small baby boom. 89,402 children were born in Switzerland last year. This is the highest birth rate in decades.
The way a woman gives birth has changed over time. While home births used to be the most common form of childbirth, obstetrics increasingly shifted to the medical field. In the last thirty years in Switzerland there has been a small but increasing demand trend back to the most natural birth possible.
As part of the new hospital list of the Canton of Zurich, which will apply from 2023, various Zurich hospitals now want to expand so-called “midwife-led obstetrics”. According to the definition of the Health Directorate, it is not a doctor, but a midwife who is responsible for preparing for the birth, the birth process and aftercare. A medical specialist is only called in if a pathological event or other complications occur.
Finding enough midwives is a challenge
According to its own statements, the Spital Zollikerberg has already received a service contract in the field of midwife-led obstetrics for next year from the health department and is planning something extraordinary: A “house of birth” is to be set up on the hospital’s own premises, as those responsible confirm to the NZZ. In it, freelance midwives are to look after the women giving birth exclusively at their own expense. The hospital bills the midwives directly and offers them the entire infrastructure should medical intervention become necessary.
“The demand for natural births is growing, and the need for security is still very important for expectant parents,” is how Pia Schnitzler, clinic director of the women’s clinic and project manager of “House of Birth” at the Spital Zollikerberg, outlines the strategy of the new offer. The “Zollikerberg” gives women giving birth a further option in addition to home birth, birth centers and the maternity wards in the hospitals.
However, the project is still in the initial phase. Above all, a pool of well-qualified midwives is likely to be decisive for success. “We are also strengthening the midwifery profession and creating an attractive workplace for this professional group,” says Schnitzler. The head of the clinic leaves it open how high the corresponding lump sum will be that these midwives receive per birth from the Zollikerberg hospital. “The fee depends on the scope of the service and the high level of responsibility that the freelance midwife bears.”
They want to recruit midwives who are already self-employed and specialize in natural births. Recruiting the desired type of midwife in sufficient numbers is likely to be the sticking point in the new project. According to the site hebammensuche.ch the number of midwives in Zurich who work freelance and have experience in natural obstetrics is very limited.
Interested parties must be “fundamentally healthy”.
According to project manager Schnitzler, women who want to give birth naturally in the “House of Birth” on the Zollikerberg must be “healthy” during pregnancy. The Nordstern birth center integrated into the Aarau hospital, which has been run by midwives for years and is comparable to the planned project on the Zollikerberg in terms of organizational form, has clear requirements: no premature births, no known previous illnesses such as diabetes, no regular use of antidepressants, no previous ones Caesarean section, no twin births and no transverse or breech position of the child.
The Zollikerberg hospital refers to the political client in this regard: “The inclusion and exclusion criteria are specified by the health department.” Exclusion criteria for a midwife-led delivery are, for example, an expected birth before the 36th week of pregnancy, positional anomalies, drug abuse or multiple births.
Acceptance of the new project within the hospital is also likely to be decisive. Five years ago, the government council announced that in a survey of Zurich hospitals on the potential of midwife-led births, “critical voices pointed to the problem of delimiting competencies in the cooperation between midwives and doctors”.
In this regard, a change in thinking seems to have taken place, at least in the Zollikerberg hospital. «The midwife-led obstetrics is very much supported and recognized by our medical profession. It is seen as strengthening our obstetrics and as an additional service,” explains hospital spokeswoman Kyra Renidear. The primary challenge, according to Renidear, lies in a well thought-out conception at the process and structural level.
The “House of Birth” on the Zollikerberg itself is meanwhile taking shape. “The expansion and renovation of the building are being planned,” says the communications officer. “The building should be equipped with three or four family rooms and with a homely ambience.” Approval from the municipality is still pending.