Hospital Care and Procedures

In this section we’ll look at procedures that might be suggested or carried out:

• when you first arrive at hospital

• once you’re admitted to the labour ward

• during labour

• during the birth

When you first arrive at hospital

‘Spontaneous’ labour (i.e. labour begins naturally)

When you first arrive at the labour ward, a hospital midwife carries out an initial assessment to try to establish how your labour is progressing.

She may ask for the ‘feuille de liaison’ (or ‘carnet de la mère’) your gynaecologist gives you towards the end of your pregnancy – this provides the midwife with a summary of your health and your pregnancy, and contains any information that may be important for your care.

She will ask you about the labour signs you are having (e.g. contractions, waters breaking) and will check:

• your weight, blood pressure, temperature and heart rate

• a urine sample, to check for protein, glucose

• your baby’s position (e.g. head-down, breech – she can tell this by palpating your abdomen) and heart rate (using a fetal monitor that is strapped around your belly or a Doppler)

She may also ask if she can perform an vaginal exam to check:

• the dilation of your cervix

• whether or not your waters have broken

• your baby’s presentation (e.g. which part of the head is coming first) and engagement (i.e. how far down your baby has moved through your pelvis)

Based on her assessment, she may suggest admitting you to the labour ward, or – if she feels that you are not yet in true labour – may ask you to go home and come back when labour is more advanced.

If you are admitted to the labour ward, the midwife will ask you to change into a hospital gown or your own nightshirt/t-shirt, and will probably monitor your baby’s heart rate for around 30 minutes, using a cardiotocograph (CTG).

To do this, you will have two electronic discs (transducers) held to your abdomen by stretchy bands – one measures your contractions, the other, your baby’s heart rate. Reading these two sets of results together helps the midwife see how your baby is responding to your contractions. 

Read more about monitoring during labour (external link).

Some hospitals have wireless CTG machines, so you may still be free to move around.

If a wireless machine is not available, rather than lying in bed you might feel more comfortable sitting on a birth ball, or standing and leaning forward on the bed. Being able to be sway or rock may help you manage contractions.

See this handy poster for some ideas of positions that can make your labour easier.

• If you have not been tested for group B strep, the midwife will offer to perform this test by taking a swab during an internal exam – this swab is then tested quickly in the hospital laboratory, and if you test positive, you will be recommended to have IV antibiotics during labour and birth.

• If you are being induced or need IV antiobiotics during labour (due to a group B strep infection) you will need an IV line in your hand/arm. While being attached to an IV pole may reduce your field of movement, it is still possible to remain active and upright during labour.

Your midwife may also suggest the following:

• placing an IV line – even if you are not being induced or need IV antibiotics, some hospitals like to place an IV line in your hand/arm so that staff have access to a vein if required later in labour (e.g. syntocinon to accelerate labour, for additional fluids should you have an epidural).
  
  Ask your care provider about practices in his/her hospital.
  
  Instead of being connected to an IV pole, the midwife may offer to place a saline lock. This means the catheter in your hand/arm is ‘locked’, and not attached to anything, therefore not restricting your movement.

• shaving your pubic/perineal area – unlike in many other countries where this practice is now rare, it is still often proposed in Belgium.
  
  It was previously thought that shaving the pubic/perinneal area reduced the chance of infection following a tear or episiotomy, but research shows no benefit in such shaving. 

• self-administered enema – another procedure that is becoming less common, this can reduce the risk of you passing faeces during the birth.
  
  The midwife will provide you with a small plastic vial which is inserted in the anus, and which, after about 5 minutes helps you clear your colon.

If you do not feel comfortable with any of these procedures, discuss the need for them with the midwife. 

Your midwife will usually then take you to your own labour room – in Belgium, labour rooms are not shared. In some hospitals you can stay in the same room for labour and birth, while in others, you may have to move room when the birth is imminent. This may also depend on how busy the labour ward is. 

The hospital midwife contacts your gynaecologist to let him/her know that you have been admitted and how your labour is progressing.

Your labour has been induced

If your labour is being induced via syntocinon (artificial oxytocin – the hormone that causes the uterus to contract), the midwife will probably start the syntocinon drip (via the IV line in your hand/arm) within an hour or so of your arrival at hospital.

It can then take some time to find the right dosage to have efficient contractions. 

As syntocinon can lead to stronger contractions than you might have naturally, your baby should be monitored continuously during labour to make sure that he/she is coping well – CTG monitoring checks how your baby’s heart rate responds to each contraction. 

Many hospitals have wireless machines, in which case you should still be able to move around.

Once you’re admitted to the labour ward

During labour you will be looked after by hospital midwives who undertake any of the standard care, procedures and general monitoring. In addition, your birth partner/independent midwife/doula if you have one can provide continuous support to help you to physically and emotionally manage labour.

Hospital midwives typically liaise with your own gynaecologist e.g. via telephone, during this time to discuss how your labour is progressing. Any suggestions to e.g. artificially break your waters or accelerate your labour using syntocinon would be discussed with you and your gynaecologist, and you would be asked for your agreement.

Fetal monitoring

The Belgian KCE guidelines recommend that – if your labour is progressing as normal, and you have not been administered any syntocinon to induce or speed up labour – your baby’s heart rate can be monitored intermittently (i.e. not continuously).

Monitoring is usually done with a CTG machine. In many hospitals wireless machines are available in which case your movement need not be limited.

If a wireless machine is not available, rather than lying in bed you might feel more comfortable sitting on a birth ball, standing and leaning forward on the bed or in another position where you can sway or rock to help you manage contractions.

See this handy poster for some ideas of positions that can make your labour easier.

Artificially breaking the waters

If your midwife feels that labour is progressing too slowly, she may suggest artificially breaking the bag of waters that surrounds your baby. With your agreement, she will then discuss this with your gynaecologist before proceeding.

During a vaginal exam, the midwife inserts a sterile ‘hook’ that she uses to gently break the bag of waters. Doing this usually makes contractions become more frequent and more intense.

Accelerating labour using syntocinon

If breaking your waters has not have the desired effect, your midwife may – again, with your agreement and after discussion with your gynaecologist – suggest accelerating your labour using syntocinon. 

Syntocinon given through an IV line in your hand/arm. The dosage can be increased or lowered depending on how you and your baby react.

As syntocinon can lead to stronger contractions than you might have naturally, your baby is likely to be monitored continuously during the rest of your labour to make sure that he/she is coping well – continuous CTG monitoring (i.e. stretchy belts around your belly that hold two electronic discs in place) will be done to monitor how your baby’s heart rate reacts to each contraction.

Eating and drinking

Whether or not you are ‘allowed’ to eat and drink during labour may depend on your choice of hospital. Read evidence-based information about eating and drinking in labour 

The Belgian KCE guidelines recommend that labouring women are allowed “to drink clear liquids (possibly with sugar) as long as there is no medical counter-indication”.

Some hospitals impose no limitations on food or drink, while others may try to limit your intake. Ask your gynaecologist about this in advance, or ask the question during a hospital visit.

Reluctance to allow eating and drinking in labour stems from the very small risk of inhaling stomach contents should a general anaesthetic be necessary. However, most caesarean births are now performed under epidural and anaesthetists can take extra precautions if they know you have eaten prior to a general anaesthetic. 

During labour 

During birth

Episiotomy

An episiotomy is a cut from the lower side of the vaginal opening, which may be necessary if your perineum (the are between the vagina and anus) is not stretching enough for your baby to pass through.

Episiotomy rates during hospital vaginal births in Belgium have dropped considerably over the past 10 years, though Flanders and Wallonie still lag behind Brussels.

Brussels

Rate variation across unidentified Brussels hospitals

Source: Données périnatales en Région bruxelloise – Année 2022

Flanders

Source: Perinatale activiteiten in Vlaanderen 2022 

Wallonia

Source: Santé périnatales en Wallonie – Année 2022

Episiotomy rates vary considerably per hospital, and since rates are not published, this is a question worth asking during a tour.

When an episiotomy is needed, the Belgian KCE guidelines recommend a diagonal cut from the vaginal opening (called a ‘mediolateral’ cut), rather than straight down.

An episiotomy is performed when the tissues are already stretched, so it is unlikely you will feel much pain. However, a local anaesthetic may be given before the episiotomy is performed. Ask your care provider about this. 

After the birth, a local anaesthetic is usually administered while your care provider stitches the cut.

How can I reduce the chance of needing an episiotomy?

There are various ways to try to avoid needing an episiotomy. Studies show that:

• perineal massage during pregnancy (where you massage your perineum – the area between your vagina and anus – yourself to increase the elasticity) reduces both injury to the perineum (whether through a tear or an episiotomy) and also perineal pain after the birth.

• upright positions for giving birth reduce the need for episiotomy and the use of ventouse or forceps, which is one of the reasons why an episiotomy may be performed.

• upright positions in general help your baby work with gravity (rather than against it if you are lying down), and let your perineum stretch more naturally. They also help your baby get into a good position for birth, thereby reducing the likelihood of needing ventouse or forceps to assist the birth.

See this handy poster for some ideas of positions that can make your labour easier.

• having an epidural increases the need for ventouse and forceps – therefore you can reduce the likelihood of needing an episiotomy by using pain relief techniques other than epidural, such as relaxation, massage, movement, water etc.

Also, when your baby’s head is ‘crowning’, your care provider may ask you to stop pushing to allow the tissues in your perineum to stretch.

Controlling your breathing will help at this moment – e.g. panting or puffing with an open mouth, or imaging that you are blowing out candles. Birth preparation classes can be a good place to learn about techniques that can make labour and birth easier. 

Read more about episiotomy, including recovering from an episiotomy