The birth scenario in Luxembourg

Disclaimer: this post does not pretend to be a thorough guide to giving birth in Luxembourg, but just a little recap of how things work around here.

Luxembourg is a very special country in many aspects, and the birth-related world is not an exception. With less than a half of the population of the country being native to the country, I thought it would be useful to gather up some information about how the system works here. We are a small country and the way the system work is quite different from our neighbours, so most of the information one can find online does not necessarily apply here.

Where can you give birth in Luxembourg?

This is probably the first question one might want to ask, and it is somewhat entangled to the following sections as well. At this moment, in Luxembourg, there are only two options to give birth: either in a hospital, or at home.

Very recently the first birth center had opened, but it was subsequently shut down as such by the Ministry of Health. We all hope that this issue will be soon fixed and that women in the Grand Duchy will have this option that is so common in the neighbouring countries! But for the moment, unfortunately, birthing homes are not an option inside the territory of Luxembourg (though some women chose to go to give birth at birth centers in other countries, as Germany). On a happier note, homebirths are since this year covered by the CNS, and so they became a more easily accesible option for women in Luxembourg.

This leaves us with hospital births, which are by far the most common option in the Gran Duchy. The country has four maternities, two in Luxembourg city, one in the south of the country, and one in the north:

• La maternité du Centre Hospitalier de Luxembourg, commonly referred to simply as CHL, is the biggest maternity in the country and the one that hosts the majority of births. It also has the most sophisticated Neonatal Unit in the area. If you are followed by a doctor from the CHL staff, then they will not necessarily be present at the moment of your birth, and you will be taken care of by the doctor on call. The most common case, however, is of being followed by a doctor outside the hospital but that is affiliated to it, and in this case, they will be called to come in when you go into labor.
• Clinique Bohler , from the Hospitaux Robert Schuman, is the other maternity in Luxembourg city, situated in Kirchberg. It also has a NICU, but it can take care of babies only after 32 weeks of gestational age, and if they weight more than 1.5kg at the moment of birth. Most doctors here work in sub-teams such that you know you will get someone from the team when you go to the hospital.
• CHEM, the maternity of the Centre Hospitalier Emilie Mayrisch, at Esch-sûr-Alzette, in the south of Luxembourg. Esch is the second largest city in the country, and the CHEM is the only hospital that was awarded the “Initiative Hôpital Ami des Bébés” by UNICEF.
• CHdN, the Centre Hospitalier du Nord, in Ettelbruck, is the maternity serving the north of the country. Before the sanitary crisis, it was the only hospital that freely allowed doulas to accompany parents during labor and birth (more on this below). Hopefully this will be the case again soon (and the rest of the hospitals will follow!)

The role of the midwives

The system in Luxembourg is mostly a obstetrician-lead model of care (in contrast to the midwifery model of care being available as an option or as the default in many other countries in Europe). This means that during pregnancy a woman is normally followed by an obstetrician, and not by a midwife, and is with her doctor that she will have all pregnancy check-ups. Since early this year, however, women can choose to be followed by a midwife during their pregnancies.

In both cases, women in Luxembourg are entitled to both prenatal and postnatal home visits by a midwife. For this, the woman has to pick a midwife from the list of liberal midwives. These visits are fully covered by the CNS. The chosen midwife will accompany the woman during her pregnancy and postpartum, but she will not be with her during labor and birth. When she goes to the hospital to give birth, the woman will be supported by one of the midwifes on call. In Luxembourg it is not possible to bring a private midwife to the hospital.

One exception to this is the case of a homebirth, in which the woman will be accompanied by the same midwife thorough her pregnancy and during her birth.

The role of the doctors

As I mentioned above, it is the obstetrician who that normally follows a woman during her pregnancy. Many doctors will also attend the birth, but there are also obstetricians that follow pregnancies but do not attend births. In this case, the woman has the freedom to chose the doctor she wants to give birth with.

In normal circumstances, the obstetrician will not be present while the woman labors, and it will be mainly the on-call midwife the one supporting the woman, and she will call the doctor only for the second stage of birth (for pushing), and sometimes only for the baby to be born. In some cases the doctor does not get there in time (it happened to me!) and then the midwives take care of the delivery without any issues.

The role of the doulas

As I mentioned briefly above, most hospitals let women come in with only one accompanying person. This person can be any person of their choice (their partner, mother, sister, etc. or a doula they hired) but it can be only one person at the same time. Since doulas are not medical staff, and the hospitals do not account for them separately, they cannot be in the birthing room at the same time as a family member, for instance (and this is not a consequence of the sanitary crisis of 2020, it was still like that before that). Hopefully this will change in the future (and the more women request and demand that their doulas can come with them without using up the “accompanying person” spot, the better!), but for the moment many doctors allow doulas and partners to switch in and out of the birthing room.

The support of a doula, however, starts well before labor, and finishes well after birth. A doula can help a woman prepare for her birth during her pregnancy, and can support her during labor at home. If she is not allowed to come to the hospital, she can still support the laboring woman and her partner through texts and calls, she can be available in case the family wants to discuss any options or procedures, or simply to give encouragement, or some tips for the partner in how to support the woman.

The advantages of having a doula is research-based, and I trully hope that the government and hospitals in the Grand Duchy will accordingly adapt their policies. In the meantime, however, I hope this posts will be of help for everyone out there trying to figure out how the system works.