Maternity care in Curaçao is at a crossroads. While many parts of the world are making progress in how they support women during pregnancy and childbirth, on our island we continue to face somewhat outdated systems and regulations that limit the care for expectant mothers. This is why we, Lysanne and Steffen, work daily to realize that change, despite the obstacles that stand in our way. Our own struggle to be allowed to work as an independent midwifery practice is just one example.
A difficult road to innovation
After a long legal battle and going through countless bureaucratic hurdles, we (Lysanne as a midwife) finally got the license to operate independently with out own practice! The victory was a bit bittersweet, because it took us almost 2.5 years to get this license, due to countless delays and incomprehensible opposition from the government. Instead of being welcomed as pioneers who want to improve maternity care on the island, we were confronted with a wall of bureaucracy and misunderstanding.
This struggle was for us a painful example of why so many island children (Yu di Korsou's), who have studied and gained experience abroad, often do not return to Curaçao. The barriers, also in other sectors than healthcare, are a big hinderance, and the support that many are used to in Europe is minimal. That we persevere, comes from our deep love for midwifery and for the island. We are determined to improve healthcare here, but it is understandable that many others who have the same ideals, can be discouraged by our story.
Our practice: a ray of light in maternity care
Despite these challenges, we have already built a beautiful practice that focuses on empowering women and their partners. Our practice, Mirasoon, is a place where pregnant women feel supported and heard. The moment you walk in, you get a feeling of peace and calm. You are not walking into a clinical waiting room. Just the color on the walls, the ambiance you create, does wonders for people, whether this is in maternity care or, for example, at a GP's practice. Feeling at ease and calm plays a major role in your health, and also in the effectiveness of the treatment or the conversation. And the latter is also important, the conversation. About 90% of care provision is actually in communication. Talking to the client, listening to concerns, and clearly explaining what could be going on, what the process could look like, and most importantly: what their choice is! Making your client/patient feel at ease through good communication is your strongest weapon in your arsenal as a care provider.
We are often asked: which ultrasounds should I actually do during pregnancy? Our first answer to that is always: you don't have to do anything! You can do as much or as little as you want. Of course, we do recommend a few specifically, but we emphasize here several times that your own body is your own choice.
Mirasoon started with prenatal ultrasounds, because we also wanted to start simple, and simply did not have a large space. We are now a fully-fledged pregnancy center with a wide range of prenatal ultrasounds, obstetric care, but also courses, coaching and personal guidance. Here we offer our clients important tools to approach the birth process from their own strength. Every woman is unique, and every birth is different. That is why we always talk openly about all possible scenarios - from natural births to interventions - so that women and their partners can make well-informed decisions at the right time that feel best for them (and well-founded).
We also conduct research, in collaboration with the UMCG in Groningen. The first results show that women in Curaçao often have a negative birth experience, especially when they are giving birth for the first time. This is an important piece of evidence for future changes in maternity care, and motivates us even more to prepare women and their partners well and give them back control over their own birthing process. Because a positive birth experience not only has a direct effect on mother and child, but also contributes to their long-term health!
The preliminary results of our research, conducted together with the UMCG
Advice to other healthcare providers
As healthcare providers, we regularly hear stories from women who give birth in hospital and have had negative experiences there. Often, these are situations in which insufficient consideration is given to freedom of choice, peace, space to move, and even consent. For example, consent for a vaginal examination or to wash the baby in a certain way.
But freedom of movement is also a thing. One of the most important aspects of a smooth delivery is giving the woman sufficient freedom of movement. We have known for a while now that women are not designed to give birth on their backs. Yet we often see that people stare blindly at the CTG (cardiotocogram), and if it is not perfect, the woman is not allowed to lie on her side, let alone on her hands and knees. Even aids such as a yoga ball are sometimes dismissed as impractical, while they can actually help facilitate childbirth. Perhaps births would go smoother and faster if women were given the space to move and assume positions that were comfortable for them. A win-win for everyone?
Having a yoga ball available in the delivery room of a hospital should be standard practice by now
These are exactly the things we encounter and hear from our clients, and it is one of the biggest reasons why we keep going. Despite the many obstacles and moments where we get caught in a negative spiral of feelings due to bureaucratic obstruction and lack of support, we are also strengthened again and again by the appreciation and love we receive from our clients. We truly love our profession and the opportunity to contribute to such important moments in the lives of women and their families.
Our advice to other healthcare providers is simple: communicate with the people in your care. Ask for their consent, discuss their options, and respect their choices. Remember that ultimately it is about them, their well-being and their experience. Good communication and respectful treatment are crucial to ensuring that women feel heard and respected during one of the most life-changing moments in their lives.
We would like to emphasize that it is not our intention to discredit our colleagues in maternity care. On the contrary, we hope to inspire them to continue to fight for improvement together. Together we can bring about important changes. After all, we are all there for the same goal: to ensure that every woman and her baby receive the best possible care.
We continue to fight for better care
Our fight is far from over. We are grateful that we have been given the opportunity to continue our work, but much remains to be done to modernize maternity care in Curacao. We will continue to work for all women on the island, because they deserve to be treated well, respectfully and competently during the most important moments of their lives.
Unfortunately, the largest health insurer in Curaçao, the SVB, has chosen not to give their clients access to the care we offer. Although these clients are of course welcome with us, the SVB does not reimburse this. Unfortunately, this outdated policy reinforces the privatization of healthcare and drives a wedge in the diversity of the population, preventing those who would benefit most from these essential changes in maternity care from taking advantage of them.
But fortunately we see that there is a lot of will for change on the part of healthcare providers and those around them, and we are determined to support that change as best as possible. We will not settle for the status quo. The birth of a child should be as powerful, positive and happy as possible. Let's make sure we do our best to make this happen as best we can for everyone in every situation.
To all expectant mothers and fathers: We stand with you. We will continue to fight for better care, for respectful treatment and for the best possible birth experience. The experience that everyone deserves.
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