Statistics suggest that up to one in five women will choose to end a pregnancy, for their own unique reason, with most doing so before 12 weeks. However, depending on the situation, it may be possible to end a pregnancy later than this.
“They are mothers, daughters, sisters, nieces, wives, aunties and grandmothers. They are politicians, lawyers, students, teenagers, nurses, police officers, women who ‘don’t believe in abortion’, waitresses, doctors, journalists, and dancers.
They come from many different religious and cultural backgrounds. They can be wealthy, getting by, or struggling financially. They are married, in long term relationships, single, divorced, having casual sex, or victims of sexual assualt. They usually share the belief that while the decision may have been difficult, they made the best choice at the time.”
In Belgium, it is possible to end a pregnancy after 12 weeks if:
- the pregnancy endangers the health of the mother; or
- the baby has been diagnosed with an incurable condition.
If the above criteria are not met, and a woman still wishes to end a pregnancy after 12 weeks, she can go to another EU country where abortion is still possible at her stage of pregnancy.
Choosing to end a pregnancy because of an incurable condition
Being told that your baby has an incurable health problem comes as a huge shock, and you may have trouble believing the news. In the following hours and days you may have a lot of decisions to make, such as whether to end the pregnancy or let nature take its course.
Making a decision to end a much-wanted pregnancy is heartbreaking, and you will have a multi-disciplinary team (doctors, midwives, nurses, psychologists) to support you through this time, and provides comprehensive information on the options available, as well as advice.
In Belgium, a ‘therapeutic termination’ can be carried out at any time until the term of the pregnancy. This gives the mother (and father / partner if relevant) the time they need to decide how to proceed. These terminations must be carried out in a hospital (and cannot take place in a family planning clinic).
For support for parents who are concerned about test results, see the website of the UK charity Antenatal Results and Choice (ARC).
What happens when?
Once the decision has been made to end the pregnancy, your doctor will explain your options to you and you will have the opportunity to ask any questions you may have.
Unless there is a reason for a caesarean birth, labour will most likely be induce d,and you willgive birth naturally. Hospital staff will be particularly sensitive to your needs, e.g. in terms of pain relief and who you want to be present.
You will have the opportunity to discuss pain relief with an anaesthetist, should you wish to have an epidural during the labour.
Around 36 to 48 hours before the birth, you will be given the drug mifepristone – this stops the hormone that allows the pregnancy to continue working. You will most likely be able to stay at home for this.
Once admitted to the hospital, labour will be induced using prostaglandins, which provoke contractions of the uterus.
If the procedure takes place after 24 weeks of pregnancy, a strong painkiller is injected into the umbilical cord to anaesthetise the baby, and the a second medication is injected directly into the baby’s heart to stop the heart.
Hospital staff will make sure you are well supported during labour, whether by your partner or someone else close to you, or if this is not possible, by the hospital staff.
After the birth, the baby is taken out of the room, but can be brought to the mother / parents a little later if they wish.
There are some ‘full-spectrum’ doulas practicing in Belgium who accompany women / couples when ending a pregnancy. See the directory for more details.
The decision of whether or not to see, hold, or photograph your baby is a very personal one, and may depend on how advanced your pregnany was. Hospital staff should respect your choice. You may want to ask staff about your baby, how he/she looks etc to help you make your decision and to help prepare you to meet your baby, if you wish to do so.
“Meeting your baby after his/her death is not morbid: its a healthy reaction that allows parents to see their baby and to give him/her a real place in their lived. It’s an extremely intimate moment that is full of emotion.”
Dr Milagros Marin-Ponce, Gynaecologist at St Luc hospital (https://www.gynandco.be/fr/linterruption-medicale-de-grossesse-y-faire-face/)
The website of the UK stillbirth and neonatal death charity Sands provides some useful practical information and suggestions about saying goodbye to your baby and ways to remember your baby.
Remember though that this is a UK website, so advice about registration and funeral formalities will not apply in Belgium. See below for further information about procedures and admin in Belgium.
Looking for answers
You will be offered a post mortem examination of your baby, which could help to explain the possible causes of your baby’s condition or abnormality and the chances of whether it could happen in a future pregnancy. A post mortem would only be carried out with your full consent, and after your care provider has explained the kind of tests that you can request to be carried out.
The UK stillbirth charity Sands has compiled a useful document aimed at helping parents make the decision of whether or not to request a post mortem.
Registering your baby’s death
The staff looking after you will be able to tell you what you need to do, and in many cases, will offer to liaise with the commune on your behalf.
If the pregnancy was ended:
|before 140 days of pregnancy||Your baby's birth/death cannot be registered.
Some parents ask for a ‘declaration of a late miscarriage’ (‘déclaration de fausse couche tardive’), which is needed if you wish to have a funeral for your baby.
See below for more information on funeral arrangements.
|between 140 and 180 days of pregnancy||Your baby's birth/death can be registered, but this is not mandatory.
Your doctor or midwife completes an official declaration of the stillbirth (‘déclaration d’enfant sans vie’ / ‘akte van een doodgeboren kind’), in which you can indicate the first name(s) of the baby – a family name can unfortunately not be given.
Since a change to legislation on 31 March 2019, the father of a baby or the co-parent who is not married to the baby’s mother, or who had not yet signed a declaration of recognition ('acte de reconaissance' / 'erkenningakte'), can declare paternity / co-parentality after the pregnancy has been ended, with the mother's agreement.
|at least 180 days of pregnancy||Your baby's birth/death must be registered.
Your doctor or midwife completes an official declaration of the stillbirth (‘déclaration d’enfant sans vie’ / ‘akte van een doodgeboren kind’), in which you can indicate the first name(s) of the baby.
Since a change to legislation on 31 March 2019:
The staff looking after you will be able to tell you what you need to do, and may be able to help you start making arrangements, such as contacting a funeral home / undertakers.
If your baby:
|before 180 days of pregnancy||In Brussels and Wallonia, if the pregnancy was ended between 106 and 180 days of pregnancy, you can request that your baby be can be either buried in a special section of your commune’s cemetery or be cremated and the ashes scattered in a special section of your commune’s cemetery – all communes should have a small area of their cemetery reserved for the burial of babies who were stillborn before 180 days of pregnancy, and for the scattering of ashes.
In Flanders, the above applies irrespective of when, before 180 days, the pregnancy was ended.
Your doctor or midwife can make the request to the commune. To be able to do this, your doctor or midwife needs to complete a ‘declaration of late miscarriage’ (‘déclaration de fausse couche tardive’) - they can the make the request to the commune for the cremation / burial on your behalf. A funeral home will take care of the transport of your baby.
|after at least 180 days of pregnancy||Your baby must be buried or cremated - burial or scattering of your baby's ashes can be in the cemetery of your choice.|
Cremation / burial cannot take place less than 24 hours after the stillbirth / death.
While Belgian mutuelles will contribute to funeral costs for a baby who was born but died shortly after birth, this is not the case for babies who are stillborn – this is because a stillborn baby has never officially been registered as a ‘dependent’ of either parent. This unfortunate loophole means that parents whose baby is stillborn may be faced with fees of around €1000 for even a simple funeral/cremation.
Some employers have been known to contribute to funeral costs. Your HR department will be able to advise you.
Note that the Crematorium de Bruxelles does not charge for cremation of a baby who was miscarried or stillborn between 106 and 180 days of pregnancy.
Admin – worth knowing
If your baby was stillborn after 180 days of pregnancy, or born but died shortly after birth irrespective of how long the pregnancy lasted, and you are part of the Belgian social security system, you are still entitled to:
- paid maternity leave and paternity leave (if the father’s name appears on the declaration of stillbirth/death certificate) – for this, you will still have to liaise with your mutuelle(s), and provide a copy of the declaration of the stillbirth / death certificate.
Note that if you wish to return to work before the end of your maternity leave, you may require a doctor’s certificate.
- the birth allowance (‘prime de naissance’ / ‘kraamgeld’) from the Belgian state – this is typically paid as of the 7th month of pregnancy, but even if you did not claim it at this time, you are still entitled to it provided the pregnancy lasted at least 180 days. You have five years from the date of the stillbirth / birth to claim the birth allowance.
Whether or not you applied for this allowance during the pregnancy, you will still have to provide your family allowance agency with a copy of the declaration of stillbirth / death certificate.
- tax deductions for your baby for the tax year in which he/she was stillborn / died – your baby is still considered as fiscally dependent for that tax year, which will entitle you to some tax deductions.
It is also worth knowing that bills for medical care related to the loss of your baby, e.g. consultations, blood tests and ultrasounds, can continue to come for quite a while after the stillbirth/death, which may feel like insensitive reminders as you are trying to come to terms with your loss.
Physical aspects for mum
|Milk production||If your baby was stillborn in the third trimester or dies soon after birth, your milk may still come in, which may be very emotionally difficult.
Your doctor can prescribe medication to help prevent your milk coming in and/or a lactation consultant can help you manage and decrease milk production.
This article may also be of some use: http://www.glowinthewoods.com/how-to-stop-lactation/
|Physical recovery after the birth||You may still benefit from some postnatal physiotherapy to help re-strengthen your pelvic floor muscles, which would have weakened during pregnancy, and which may have weakened further during a vaginal birth.
In addition to the nine sessions of perinatal physiotherapy you are entitled to per pregnancy, each calendar year you can also have a total of 18 sessions for a specific reason (i.e. two additional prescriptions of nine sessions each) and so, any extra sessions you need can be taken under the umbrella of 'pelvic floor re-education'.
Emotional and psychological support
- An independent midwife is a good point of contact for holistic support after ending a pregnancy. This is also covered by the mutuelle.
- Community Help Services offer a helpline (+32 (0)2 648 40 14) as well as English-speaking psychologists, psychotherapists, bereavement counselors.
- The Brussels Childbirth Trust (BCT) has an ‘Experiences Register’ – this allows BCT members to be put in touch with other members who have experienced stillbirth, and who can offer support and advice.
- Waterloo-based mum Joanne Fraser has set up a support group, Pregnancy and Infant Loss Support Belgium, for the loss of a pregnancy, stillbirth, infant death, conceiving or expecting after a loss.
“It is a terrible thing to have to go through the loss of a baby in a foreign country away from family and friends. Even worse is not having anyone to speak to about it.”
Joanne has been involved in grief support for a while now and – having not really found a group here in Belgium – decided to start one. The group currently has a closed Facebook group, which gives an opportunity to meet and support each other.
For support for parents who are concerned about antenatal test results, see the website of the UK charity Antenatal Results and Choice (ARC).
This website provides a wealth of information for women who may need to end a pregnancy and who are struggling emotionally: https://www.childrenbychoice.org.au/forwomen/afteranabortion
Reading other people’s accounts
Three women tell their stories of late-term ending of their pregnancies: https://www.theguardian.com/society/2017/apr/18/late-term-abortion-experience-donald-trump