Choices, choices

Choices, choices
17 September 2021

We are blessed to live in a country with one of the best healthcare systems in Europe, but, navigating the system is not without its challenges, and I don’t mean the bureaucracy! The main challenge that taxes me, the couples I see attending the BCT Pregnancy in Belgium evening and the chatter on the Facebook group, is how to cope with the available choices in where we wish to be treated during pregnancy and who treats us. We have the luxury of being able to attend any healthcare establishment we wish, quite literally walking in off the street (although I would suggest a referral from private or practice-linked general practitioner/family doctor is a better way to access services).

With somewhere in the region of 13 hospitals in the Brussels area where you can birth your baby, and goodness knows how many across Belgium, as well as the possibility of a home birth (all offering good medical care but with their own philosophies, protocols and procedures), the choice can be overwhelming: how do you go about choosing and what are the options?

A starting point might be to ask yourself a series of questions to help you identify what your personal priorities are, and put them in order of importance, such as:

  • Who do you want to care for you during your pregnancy?
  • Specific medical problems
  • Locations of gynaecologists/midwives offices
  • Where the hospitals are
  • Facilities offered by various hospitals
  • What kind of birth would you prefer?
  • Who is going to support you during labour and birth?

 The first key choice is ‘who is going to look after you in your pregnancy and birth?’

Then you can begin to explore the options that best fit with your personal priorities.

The first key choice is ‘who is going to look after you in your pregnancy and birth?’. It could be a gynaecologist, an independent midwife or a combination of both. Some family doctors also offer antenatal care and perform deliveries. You might ask your doctor if he/she offers this.

Gynaecologist-led care: In Belgium, gynaecologists are affiliated to a certain hospital (very occasionally, more than one), which means they can only deliver babies in that hospital.

So, you can either choose:

  • your gynaecologist through recommendation and give birth in the hospital where that gynaecologist works
  • your hospital (e.g. based on a recommendation or because of its location) and then find an affiliated gynaecologist who can deliver your baby

It can be frightening when faced with so much choice especially when it comes to the birth of your baby, where the stakes are high.

Midwife-led care: It is possible to be looked after by a midwife during your pregnancy and birth. Like the gynaecologists, midwives are affiliated to certain hospitals but, unlike consultations with a gynaecologist, consultations with most midwives are fully reimbursed by your mutuelle/ basic health insurance.

With an independent midwife you can give birth either

  • at home
  • at one of the five Brussels hospitals that allow independent midwives to deliver babies (currently Erasme, Sainte-Elisabeth, CHU Brugmann, Ixelles-Etterbeek and Clinique St-Jean). Your own midwife cares for you during your labour at home and then in hospital, and delivers your baby.

It can be frightening when faced with so much choice especially when it comes to the birth of your baby, where the stakes are high. You could delve into the world of business and find plenty of models out there to help you make your choice. They usually follow a process of:

  • identifying the problem
  • gathering information
  • exploring the risks and benefits
  • evaluating the alternatives
  • selecting the best option

But, they only go so far. You still have to factor in your instinct (that powerful impulse where something feels

natural rather than reasoned) and your emotions. Then to top it all you might not know what you want and then, if you do know what you want, you might not be able to explain what you want. So, try and make the choices/options real to you. Don’t just rely on hospital websites and the views of colleagues, friends and fellow BCT members. Get out there and visit the hospitals, talk to the gynaecologists and midwives and see what they have to say. Use the list of personal priorities you identified to guide the questions you ask of them.

Most hospitals run tours of the maternity departments. It is probably easier to call the department to find out when they are. Often they will be run in French, Dutch, sometimes English and occasionally German. By visiting the hospital you can see the facilities at first hand, find out about their philosophies and exactly what they offer. Remember, if you feel the choice you have made does not sit comfortably with you then it is possible to change your mind.

 Ultimately, though, what is important is not the process you use to arrive at your decision but how satisfied you are with the choice you make.

Ultimately though what is important is not the process you use to arrive at your decision but how satisfied you are with the choice you make, and that depends largely on whether you can claim ownership of your choice. In the context of pregnancy and a woman’s childbirth experience, choice and control are intimately connected and have a direct impact on a woman’s satisfaction with her birth experience. Take time to consider what you really want and need (maybe even before you plunge into the cyber world of information overload), be informed about the available options and understand the consequences associated with each choice.

As best-selling author and life coach Cherie Carter-Scott states in her book ‘If life is a game these are the rules’ (pub Galaxy Brands 2010) ‘there are no mistakes, only lessons and we should love ourselves, trust our choices, and everything is possible!

By Kate Ellwood

This article was first published in the January/February 2015 edition of the BCT’s Small Talk magazine.

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