Who looks after me?

In Belgium, pregnancy and birth are typically highly medicalised and most women are looked after by a gynaecologist / obstetrician, even if their pregnancy appears to be a normal, low-risk pregnancy. 

However, demand for midwife-led care is increasing, and there are more and more options for midwife-led care, whether in a home, hospital or birth centre environment. 

In this section you can read more about: 

You can also read more about the role the following people can play before during and after birth:

* Note: Some family doctors also offer antenatal care and attend births. Ask your doctor if he/she offers this.  


Basic principles of health care in Belgium

Belgium’s healthcare system is excellent, and is funded by social security contributions (whether you are an employee or self-employed) and mandatory healthcare insurance coverage with one of the healthcare insurance funds (‘mutuelles’/’mutualiteiten’).

Health insurance coverage also automatically covers children up to the age of 18 and dependent spouses.

‘Mutuelles’ / ‘mutualiteiten’ typically cover around 50-75% of medical visits, consultations etc, and also partly cover the costs of prescription medication.

Choice of care provider

Unlike in many countries, in Belgium there are no restrictions on which healthcare provider(s) you can see to be entitled to subsidised care, provided that person is registered with the National Institute for Health and Disability Insurance (INAMI / RIZIV). For example, you can see a doctor in your own commune, or 100km away; in a hospital setting, or in private practice.

You can even arrange to see a specialist doctor yourself, e.g. pediatrician, gynaecologist, urologist, although note that your mutuelle will reimburse more of the cost if you have been referred by a general doctor.

Costs

The fees that a healthcare professional charge depend on whether or not they are ‘conventionné / ‘geconventioneerd’. A healthcare professional who is ‘conventioned’ adheres (either fully or e.g. on fixed days) to the fee schedule fixed in the convention with the mutuelle. One who is not conventioned fixes his/her fees freely, and costs can vary considerably.

Your mutuelle will reimburse you the same amount for e.g. a visit to a gynaecologist, irrespective of whether the care provider is conventioned, so your final ‘out-of-pocket’ costs will be lower if you choose a conventioned doctor.

At many care providers you will need to pay up front and then submit a request for reimbursement, while some offer a third-party payment system where you do not need to pay yourself.

Reimbursements are usually processed quickly, and are typically paid onto your bank account.

Read more about the costs related to pregnancy and birth here.


Gynaecologist-led care

In Belgium, most women are looked after by a gynaecologist during pregnancy, even if the pregnancy appears to be a normal, low-risk pregnancy. You do not need to be referred by your family doctor, and are free to choose any gynaecologist.

However, gynaecologists are affiliated to a certain hospital (or in some cases, more than one hospital), which means that they only attend births in that hospital.

So, you may prefer to:

  • first, find a gynaecologist (e.g. based on a recommendation, or one that is situated near where you live) and then accept to give birth in the hospital where that gynaecologist works;

    OR

  • first, choose a hospital (e.g. based on a recommendation or because of its location) and then find a gynaecologist who attends births there.

What does my gynaecologist do, and when? 

During pregnancyYour gynaecologist usually sees you once a month for the first 28 weeks of pregnancy, every fortnight until 36 weeks, and then every week until the birth.

He/she can carry out or organise all the tests and checks during your pregnancy.

If he/she has the necessary equipment and training, your gynaecologist may perform all your ultrasounds - if not, he/she will provide you with the necessary paperwork to have the three 'official' ultrasounds done by a sonographer.
Labour and birthHospital midwives will provide most of the care during labour. If they feel any procedures or interventions are warranted during labour (e.g. artificially breaking your waters or accelerating labour with syntocinon) they will discuss this with you, and then consult your gynaecologist and ask his/her agreement before proceeding.

They will also liaise with your gynaecologist so that he/she will arrive in time for the actual birth. Depending on how your labour progresses, it can happen that your gynaecologist is only present for a very short time before your baby is born.

After your baby is born, your gynaecologist ensures that the placenta is completely delivered and that blood loss is under control. If necessary, he/she performs any stitching to your perineum. After this, hospital midwives take back responsibility for your care.
Postnatal periodYour gynaecologist will visit you before you leave hospital to ensure that you are recovering well, and will sign the hospital discharge papers when you are ready to leave.

The next time you see your gynaecologist is typically six weeks after the birth, for a postnatal check-up.

How much does a visit to my gynaecologist cost?

Most gynaecologist are not ‘conventionnées’ / ‘geconventioneerd’ and so are free to fix their fees. A typical consultation may cost around €50. Irrespective of the kind of insurance you have, you will probably have to pay this amount in full at the time of the consultation. If you are registered with a ‘mutuelle’ / ‘ziekenfonds’, around 75% of this is reimbursed.

Remember that some ‘top-up’ hospitalisation insurance providers reimburse ALL supplements for birth-related expenses that you incur in the month before, and the three months after the birth. Ask your insurer about this.


Midwife-led care

It is also possible to be looked after by a midwife during your pregnancy. Unlike consultations with a gynaecologist, consultations with many midwives are fully reimbursed by your mutuelle/basic health insurance.

If you are looked after by an independent midwife, you can give birth either:

Read more about finding an independent midwife.

What does my midwife do, and when? 

During pregnancy Your midwife usually sees you once a month for the first 28 weeks of pregnancy, every fortnight until 36 weeks, and then every week until the birth.

She can carry out or organise most of the tests and checks during your pregnancy, though some consultations with a gynaecologist may still be recommended.

Your midwife will provide you with the necessary paperwork to have the three 'official' ultrasounds done by a sonographer.
Labour and birth Your independent midwife can:
- provide support and care during a homebirth and deliver your baby in your own home - a second midwife will also attend as back-up and for support;

- if she practises hospital births, provide support and care during your labour at home and in hospital, and deliver your baby in hospital;

- provide support during your labour at home and accompany you to the hospital, where medical care during labour is provided by hospital midwives, and a gynaecologist will deliver your baby
Postnatal period Irrespective of where you gave birth - or whether or not you saw a midwife during your pregnancy - you can still see an independent midwife after the birth.

If you want to leave hospital earlier than the usual 4-day stay, you can organise to have your postnatal care from an independent midwife in your own home. Or even if you stay in hospital for the usual period, you might still want to see an independent midwife for any issues or questions you may have, e.g. for advice on breastfeeding, family planning, postnatal checks, advice on baby care.

Some independent midwives also offer postnatal exercise classes and pelvic floor re-education.

How much does a visit to my midwife cost?

Many midwives are ‘conventionnées’ / ‘geconventioneerd’ and apply the same ‘conventioned’ tariff. A typical consultation costs between €25 and €35 (this may also vary depending on whether you see her on a week-day or weekend).

You may have to pay this amount in total at the time of the consultation, or the midwife may operate a third-party payment system, whereby she recuperates her fee directly from the ‘mutuelle’ / ‘ziekenfonds’ if you are registered with one.

For midwives who are ‘conventionnées’, your mutuelle reimburses 100% of the cost of consultations (note: this is not the case for special ‘birth preparation’ sessions offered by your midwife – these will only be partly reimbursed). If she is not ‘conventionnée’, your mutuelle reimburses around 75% of the cost.

Remember that some ‘top-up’ hospitalisation insurance providers reimburse ALL supplements for birth-related expenses that you incur in the month before, and the three months after the birth. Ask your insurer about this.


Physiotherapists

In Belgium, physiotherapists often play a considerable role during pregnancy, labour and birth, and for post-natal recovery.

While you are free to choose any perinatal physiotherapist, in order to be partially reimbursed from your mutuelle / ziekenfonds for prenatal and postnatal physiotheraphy, you will need to have a prescription from your gynaecologist/midwife, which you’ll usually receive about half way through your pregnancy. 

Read more about finding a physiotherapist.

What does my physiotherapist do, and when?

During pregnancy Many women start weekly group exercise classes with a physiotherapist around the 6th month of pregnancy. These classes typically incorporate gentle exercise, preparation for the birth (breathing techniques, positions), and general tips for dealing with pregnancy-related issues such as lower back pain, sciatic nerve pain.

Women usually attend without their partner, though some physiotherapists organise sessions for partners where they can learn some massage and other comfort techniques for labour. While it is possible to arrange for individual sessions, group classes can be a nice way to meet other mums expecting their babies around the same time.
Labour and birth Your physiotherapist may offer labour support, which is especially useful if you hope to give birth without an epidural - though a physiotherapist can still offer support and advice on positions etc if you have an epidural. You usually contact your physiotherapist yourself when you decide to go the hospital, and agree how soon he/she will come to support you.

Some hospitals do not allow external physiotherapists and instead have an internal team who offer labour support.
Postnatal period A hospital physiotherapist often visits the day after the birth to perform some basic checks (notably on how your uterus is returning to its pre-pregnancy size and position) and to explain some basic exercises to strengthen the pelvic floor muscles. If your own physiotherapist has the necessary agreements with your hospital, he/she may also be able to visit you in hospital as of the second day.

Between 4 to 6 weeks after the birth, many women start postnatal physiotherapy sessions, whether individually or in a group. The aim of these sessions is to work on strengthening the pelvic floor and abdominal muscles, and gently get you back into shape.

If you continue to have issues caused by a weak pelvic floor (e.g. leaking urine when you sneeze, laugh etc), it is also possible to have internal pelvic floor therapy, where a small probe is used to help work the muscles. See above for information on how many physiotherapy sessions you are entitled to.

How often can I see my physiotherapist? 

In theory, you are entitled to nine sessions of perinatal physiotherapy per pregnancy. In addition to this, each calendar year it is possible to 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’.

Physiotherapist support during labour

Some independent physiotherapists also offer labour support, and will be affiliated with certain hospitals. Ask your physiotherapist about this.

Not all hospitals accept ‘external’ physiotherapists, and instead have an internal team who offer labour support. Ask about this when you visit hospitals.

How much do physiotherapy sessions and labour support cost?

Some physiotherapists are ‘conventionnées’ / ‘geconventioneerd’ and so apply the same ‘conventioned’ tariff, while the others are free to fix their own tariffs. 

Group pre-/post-natal physiotheraphy classes may cost in the region of €30, and if you are registered with a ‘mutuelle’ / ‘ziekenfonds’, around 60% of this will be reimbursed. 

Labour support may cost around €250 and is not typically covered by the mutuelle, though some mutuelles offer extra reimbursements for physiotheraphy, over and above the usual cover. Labour support may be fully covered if you have ‘top-up’ hospitalisation insurance that reimburses ALL supplements for birth-related expenses that you incur in the month before, and the three months after the birth. Ask your insurer about this.


Doulas

The term doula – borrowed from ancient greek and meaning ‘a woman at serving another woman’ – refers to a woman who provides emotional and physical support to a mother before, during and just after birth.

Most doulas are mothers (or even grandmothers) themselves and their goal is to accompany the future parent(s) on their journey of discovery, all the while respecting the choices and wishes of the parent(s). The extent of the support provided will depend on your needs and on the agreement you have with your doula.

Not all doulas offer the same range of support – some offer support principally before the birth, others support during the birth, and others support in the early postnatal period. Some doulas cover the entire pregnancy, birth and early postnatal period.

Note that doulas do not offer medical advice, and in no way replace the advice of a midwife or gynaecologist.

Doula support during labour

Having continuous support during labour can make a huge difference to how your labour unfolds. It can help you feel safe and reassured, help you deal better with pain and discomfort, and that person can encourage you and help keep you mobile. All of this can help you tune in to you natural birthing instincts and make for a smoother experience for you and your baby.

However, if you give birth in hospital, your hospital midwife will not be able to stay by your side for all of your labour. And your partner might feel overwhelmed or unsure of how to really help you, and need some extra support himself/herself. A doula can work together with your partner, and is actually there to support both you.

A 2013 Cochrane review of 22 separate randomised control trials (involving a total of over 15,000 women) showed that women with continuous birth support were:

  • more likely to have a spontaneous vaginal birth
  • more likely to be satisfied with the birth experience
  • less likely to have an epidural
  • less likely to have a caesarean birth or need forceps or ventouse during vaginal birth

The review also found that “continuous support was most effective when the provider was neither a medical professional nor the woman’s social network”, leading to two further benefits:

  • shorter labours; and
  • higher five-minute Apgar scores (a test used to assess your baby’s well-being in the first 5 minutes after birth)

Worth knowing

Many hospitals still follow a policy of allowing only one labour supporter, i.e. including the birth partner. However, the Belgian KCE Guideline to low risk birth advocates the presence of another person (professional or otherwise) if the couple wish.

Ask your hospital about their policy. Some may ask that you inform them in advance if another person will be present, and may provide you with paperwork to complete.

How much does it cost to have a doula?

The fee charged by a doula can vary, but is usually in the region of €50 to €60 per hour, often with a fixed fee for labour support. In Belgium, if your doula is registered with the Association Francophone des Doulas de Belgique (the French-speaking doula association) she must respect the AFDB fee structure.

Support from a doula is not usually reimbursed by the mutuelle/ziekenfonds.

Many doulas are also open to negotiating fees if money is an issue. Alternatively, you may be able to find a ‘doula in training’ who has to support a certain number of mothers for a reduced fee.

Read more about finding a doula


Reimbursement of all costs incurred in the ‘hospitalisation period’

Remember that some ‘top-up’ hospitalisation insurance providers reimburse ALL supplements for birth-related expenses that you incur in the month before, and the three months after the birth, i.e. they will reimburse the part that the mutuelle doesn’t reimburse.

Check with your insurance company how their policy works and what you have to do to have these costs reimbursed. Sometimes you may need to keep a copy of the bills you send to the mutuelle for reimbursement, and then send these to the hospitalisation insurance provider, who will reimburse the outstanding portion.


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