Mother-Assisted Cesarean: Reclaiming Choice with Dr. Koen Deurloo

In this episode, Augustine sits down with Dr. Koen Deurloo, a Dutch gynecologist at the Diakonessenhuis in Utrecht and the first physician in the Netherlands to perform a maternal-assisted cesarean (MAC) — a technique that lets the birthing parent help lift their own baby from the incision during a planned cesarean. What began as a single patient's request in 2018 has grown into a practice Dr. Deurloo has now performed more than 200 times, and one he freely shares with hospitals around the world.This conversation goes far beyond the surgical technique. Dr. Deurloo talks candidly about the home births of his own two daughters and how that experience shaped his respect for the midwifery model of care, learning to ask "why" instead of overriding a patient's choice, and building one of the most collaborative OB-midwife relationships in the Netherlands — a country where roughly 90% of pregnancies start with midwifery-led care. He shares research on women who request care outside standard guidelines, why the "dead baby card" says more about a provider's own trauma than about safety, and how he trains residents, midwives, and doulas to work from a shared goal instead of competing silos.Dr. Deurloo is also the author of Door de ogen van een gynaecoloog ("Through the Eyes of a Gynecologist"), a collection of 35 stories from his clinical life.Whether you're a physician, midwife, doula, or student, this episode offers a rare, first-hand look at what it looks like when a high-risk hospital system chooses trust and autonomy over rigid protocol — and how that shift actually happened, person by person.In this episode we cover:The story behind the first maternal-assisted cesarean in the Netherlands and how the procedure has evolved since 2018What selection criteria Dr. Deurloo uses for MAC, and why he doesn't offer it routinely to every patientHow the Dutch maternity system integrates first- and second-degree midwives with hospital-based obstetric careDr. Deurloo's research on women who request birth outside clinical guidelines — and what happened to their outcomesReframing the "dead baby card" as a signal of provider trauma, not patient riskHow to build trust between physicians, midwives, and doulas without changing the actual clinical carePractical advice for starting pilot programs and finding your "pioneers" when introducing new practices into a hospital systemResources & Links: 🔗 Follow Koen on Instagram for MAC photo series and behind-the-scenes footage: www.instagram.com/kldloo