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Brussels Local Reference INFOrmation
The administrative details you need to know if you are giving birth in Belgium. Who to contact and what to expect from the Belgian system: maternity leave, midwives, vaccinations and registering the birth.
Prenatal care in Belgium is well organised and well funded. Mothers-to-be are closely monitored and offered many tests and scans. Attention is given to preparing the mother physically and psychologically for the birth of the child. Organisation and provision of prenatal care varies slightly according to community, but essentially two organisations supervise and set the national standards.
What to do if you are pregnantThe precise nature of care varies with community. However, in the first instance visit a General Practitioner. In the Flemish community the GP will play an active role in prenatal care assisted by a gynaecologist or obstetrician in private practice. In the French community care tends to be handled almost exclusively by a gynaecologist or obstetrician working in the private or public sector. The GP can advise on choice of gynaecologist, or enquire at the local hospital. Alternatively, contact an organisation such as the Brussels Childbirth Trust (BCT) for recommendations.
Services provided by ONE or K & G are free of charge. Most other costs associated with the pregnancy, the birth itself and subsequent stay in hospital are covered by compulsory medical insurance which all employees and the self-employed must have. Even without insurance a pregnant woman will never be denied care. Payment comes from the Public Social Welfare Centre (CPAS/OMCW). There is one in every municipality and they are listed in the telephone directory.
Prenatal careOnce pregnancy is confirmed, a Maternity booklet (Carnet de la Mère) is issued to the expectant mother and she must take this with her to all consultations with her GP or any other medical practitioner. Prenatal consultations most commonly take place at the local hospital or at a clinic. Their purpose is to ensure a successful pregnancy and to minimise the likelihood of premature and underweight babies. The mother's health is closely monitored and tests are offered for various foetal abnormalities. The mother-to-be will almost certainly spend time during pregnancy with a Medical Social Worker (travailleur médico-social, TMS). The TMS is a childcare expert employed by ONE. Their services are free and they can be consulted at medical centres and hospitals or will make home visits if requested. They are professional nurses or qualified in the field of social work. During pregnancy their role is to work with the gynaecologist to monitor mother and baby and to prepare the mother physically and psychologically for birth and breast-feeding if she wishes. They may be present at consultations with other medical staff if required to explain clearly any medical terminology. They are also fully conversant with the full range of social security benefits and can advise on eligibility and application. In the event of an unplanned or unwanted pregnancy the TMS supports the parents and can offer help and advice if they opt for a termination. In Flanders, pre-natal care is mainly provided by gynaecologists. The K & G offers services free of charge to expectant parents and families with children under the age of three. These include information evenings, home visits by a district nurse, support and guidance
Other prenatal classes/careThe TMS and the K & G are directly or indirectly involved with all aspects of prenatal care including breathing classes, talks on feeding and the birth itself. Other organisations such as the Brussels Childbirth Trust (BCT) organises its own English-language classes for expectant mothers. Full details of cost, course content and enrolment procedure can be found on the website. The Community Help Service (CHS) can help with questions from English speakers on all aspects of life in Belgium. The CHS produces a booklet called "Having a Baby in Belgium"; stockists are listed on their website. Working during pregnancyWomen should tell their employer of the pregnancy at the earliest opportunity and at the latest eight weeks before the official due date. Whether or not a woman can continue working during pregnancy obviously depends on the nature of the work that she would normally undertake. The GP or medical staff responsible for prenatal care will advise. If they consider the work to be unsuitable, the woman either stops work or the employer finds her alternative work for the period of the pregnancy. If she is advised to stop work it is likely that the risk is listed as a maladie professionelle in which case the Fund for Professional Diseases (Fonds voor de beroepsziekten, FBZ/Fondes des maladies professionelles, FMP) makes a payment for temporary incapacity. If she remains at work but transfers to another role, the FMP/FBZ will make up any loss of salary as long as the risk is listed as a maladie professionelle. Payment of benefit or income replacement in both instances begins on the first day of any change. The Birth (l'Accouchement)HospitalsMost women still opt to give birth in hospital and the choice of hospital will be decided in conjunction with the gynaecologist. Following the birth it is normal to spend five days in hospital. As well as the usual medical carers, a physiotherapist will assist at the birth and in the weeks afterwards to ensure that the body recovers properly after the birth. The gynaecologist/obstetrician will almost certainly be present for the birth. Many women also choose to have a physiotherapist present to assist with pain relief. If the parents have not already had contact with the ONE during pregnancy they will receive a visit from a TMS on or shortly after admission to hospital. Home BirthsHome births (l'accouchement à domicile) are available across the country. Mothers considering this should discuss it with their medical team as early as possible. It is only an option if the mother is in good health (no hypertension or pre-eclampsia) and the pregnancy is progressing normally and the baby arrives between 37 and 42 weeks. Women who have previously had a caesarean section or who are expecting twins will be strongly urged to give birth in a hospital. A home birth is normally arranged and overseen by two experienced midwives. During the birth they can arrange transfer to hospital if the mother wishes, if she needs an epidural or if they are concerned for the wellbeing of mother or baby. In the months and weeks prior to the birth the woman must undergo regular checks and choose a hospital and doctor in case she needs one. The midwife will visit the home to advise on practical arrangements such as heating and equipment for when the baby arrives. After the birth the midwives take care of mother and baby and will stay several hours until they are satisfied that all is well and normal. One midwife will then visit every day for 12 days (staying at least an hour) to check on progress and provide any medical assistance required. The baby must also be seen by a doctor during its first week of life. The cost of a home birth and the post-natal care can usually be reclaimed in full from the insurer depending on the type of insurance.
Clinics and "birth houses"Women may also give birth in a maternity facility known as a birth house (maison de la naissance). Here the atmosphere is deliberately more homely and less clinical. Women are attended by experienced midwives and the birth is allowed to proceed at a pace which suits mother and baby. Clinics are also available where a woman can give birth and then return home the same day or the day after. The usual safeguards apply, however, and transfer to hospital will be advised where necessary. Again as with home births this route is not open to all women. Most birth houses offer prenatal consultations, baby massage, post natal home visits, family planning advice, pre and post natal talks and classes and general support and advice. Again, many insurers reimburse the costs of this care.
Water BirthsWater birth (l'accouchement dans l'eau) is popular in Belgium. Facilities are provided in some hospitals and birth houses. Water birth is suitable for a lot of women but again there are some conditions, such as hypertension in the mother or foetal distress, that mean this is not an option for every woman. Women wishing to have a water birth should ensure that they choose a gynaecologist who is in favour of this procedure.
Neonatal careIn the event of a premature birth or the baby requiring specialist neonatal care, facilities in Belgium are good but not all hospitals have the facilities. However, the TMS are present in neonatal care centres and work closely with the medical teams to ensure that parents are kept informed and provide advice on additional care requirements on transfer home. After the BirthAt birth each child is issued with a record book known as the Carnet de L'Enfant and this should be taken along to any consultation about the child's health or well being. It contains slips (vignettes) for vaccinations due in the first 18 months of the child's life. These slips are given to the medical practitioner who administers the vaccination and they allow him to give the vaccination free of charge. The Carnet de L'Enfant is also be used to record details of the child's physical and social development, for example, weight and height, sight and hearing tests. Registering the BirthBabies born in Belgium can assume Belgian nationality at birth only if the parents have lived in Belgium for at least five consecutive years in the ten years prior to the birth. According to Belgian law, the birth of a child in Belgium must be registered within 15 days of its occurrence at the Town Hall (Maison communale/Stadhuis) of the place of birth – not where the parents live. To register the birth the following are needed:
In return parents are provided with various forms which they can then use to apply for benefits, etc. Non-Belgians are advised to register the birth of children with their consulate at the earliest opportunity to ensure that they can claim citizenship for the child. Post Natal CareONE (or K & G) continue to supervise post natal care once mother and baby have returned home. Doctors (including paediatric specialists) as well as the TMS see both mother and baby on a regular basis during the early years. The TMS in particular will often visit the new family at home or see mother and baby regularly at one of the access points (including hospitals and clinics) throughout the country. The TMS is the new mother's first point of contact for most practical help including dietary advice, and general development. VaccinationsVaccinations are provided free of charge and details of what is due and when are given in the Carnet de l'Enfant. The TMS can answer questions if parents have concerns. Vaccinations are often carried out at a consultation with an ONE representative, but equally the family GP may administer them. There are vaccinations at 2 months, 3 months, 4 months, 12 months and 15 months. BenefitsMaternity BenefitWomen receive maternity benefit whilst on maternity leave. The benefit is equivalent to 82 percent of salary for the first 30 days and then drops to 75 percent of salary, subject to a maximum salary. Women may take up to 15 weeks maternity leave. At least eight weeks must be taken after the birth and at least one week must be taken before the date when the baby is due. Following the birth of a child, the father has a right to ten days paternity leave, seven of which will be paid for by the social security system at 82 percent of salary (subject to a maximum). Registering for BenefitsFor employed people administration of family benefits is handled by the National Office for Family Benefits for Salaried Persons (ONAFTS). They have offices in all the major cities including Brussels. Salaried workers must apply via their employer in the first instance as it is their specific scheme into which they have been paying contributions that will make payment of benefits due.
The self-employed must approach the fund for independent workers, INASTI. Anyone who does not fall into one of the categories above can apply for a guaranteed family benefit via the social assistance scheme. The TMS can advise on benefits and the application process. Birth Payment (Allocation de Naissance)The father applies for the birth allowance (L'allocation de naissance). If he is not a salaried worker then the mother may apply. Failing that another member of the household may be able to apply if they are in employment. The benefit may be applied for at any time from the sixth month of pregnancy. The medical staff undertaking the prenatal care will provide the necessary documentation to confirm the pregnancy. Payment is made to the mother directly (usually via bank transfer) at any time from the eighth month of pregnancy. Amounts vary depending on whether it is a first child, second or subsequent child or a multiple birth. After the birth it is essential to provide the benefit authorities with proof that the birth took place. This will be provided by the local authority following the registration of the birth. In the event of a still birth a different form, which records that a child was stillborn, must be submitted. The birth allowance is still paid in this case. Further Information
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