Birth culture has changed a lot since the 20th century: the way pregnant women are treated, the way they give birth and also the job of a midwife. So what are the choices in Luxembourg for women to give birth today?

People in Luxembourg frequently think that they have to give birth in a hospital, and many are not even aware that they can choose other birthing places. Pregnancy and labour are often seen as diseases and risks in our society, and our modern medicine tends to take away the natural power women have to give birth. During pregnancy, most women don’t see any specialist but a doctor, who is concentrated on medical aspects.

Certainly hospitals are a good place to deliver, as you have all the medical staff, medical equipment and a secure surrounding. Mortality and morbidity rates have gone down since we began “controlling” birth, and the c-section can save lives, but are all pregnant women at risk?

A minority of people have always been searching for another option. They do not associate birth with a disease, do not feel sick and do not understand why they should go to the hospital to deliver. They want to be treated as human beings, as birthing has not only physical but also psychological impacts on the mother, the life of the future child and even society. Michel Odent, French obstetrician and childbirth specialist, has said: “To change the world, we must first change the way babies are being born.”

According to article 5 of the “Règlement grand-ducal du 22 novembre 2019”, midwives are allowed and qualified to supervise, follow up with and assist a woman for a physiological birth; they can detect problems and collaborate with a doctor as soon as the situation gets bad.

And yet, birthing centres or midwifery-led units do not exist in Luxembourg, even though in all of our neighbouring countries they do.

The history of giving birth in Luxembourg

In an interview with journal.lu, Martine Welter explains that the change started in the middle of the 20th century, when hospitals got more and more common and giving birth in the hospital was promoted by the government. At the same time, Welter says, midwives began losing their status of the “art of healing” while doctors did not. Since then, midwives have only qualified as caregivers. This was a huge loss of autonomy and they had to “obey” the doctor. Over the years protocols in hospitals got stronger and pregnant women lost more and more their responsibility and self-esteem surrounding their birth-giving. They turned into care-takers, even though a birth is not a disease.

Some midwives have continued to fight for their own and for pregnant women’s rights. Over the last 40 years there have always been one or two (not many) midwives in Luxembourg who offered homebirths, even though there was no reimbursement by the state. According to Danielle Federspiel-Haag, a midwife in Luxembourg since 2005, the demand for homebirths has also been rising since the covid-19 pandemic.

Finally, a huge success came in early 2022 when, after a long and steady fight from the Association Luxembourgeoise des Sages-Femmes (Midwives Association of Luxembourg), the national social security started to reimburse independent midwives for homebirths.

Out-of-hospital births

With this reimbursement the idea to create a birthing centre was born. The Lunata birthing centre opened in September 2022 in Bertrange. Unfortunately, however, Luxembourg has no legal framework for a birthing centre. Due to huge political pressure, the Lunata centre two months after its opening and the only choice to deliver out of hospital will stay a homebirth, where the conditions are not always optimal.

Anne Dahm, who has worked as a midwife since 1999, at first in hospitals and additionally from 2013 onwards as an independent, notes the difference between in-hospital and out-of-hospital births. She explains that at home or in a birthing centre the woman delivering can stay in a cosy, familiar place. Federspiel-Haag agrees, adding that the midwife and the woman will also have already known each other for a few months, unlike in a hospital.

“[The midwife] can better concentrate on this specific woman and detect possible problems earlier, through a closer follow-up,” says Dahm. 

Ekaterina had a homebirth in Luxembourg in September 2022. In a text exchange she said that homebirth “is the most natural, the most gentle, the most calm way for me to give birth and for my kids to be born. At my own speed, with the respect of my desires, no rush, no rules, no ‘you have to’ or ‘this is the protocol’.”

Women who prefer homebirths often “have a strong personality and know what they want,” says Dahm.

It is a common desire of both Dahm and Federspiel-Haag that the future brings a different view of birthing, a real choice, and that women get more support to deliver where they choose. According to Federspiel-Haag: “giving birth in a natural way [leads to] healthy, powerful, self-confident children and teenagers.”