The midwife: Your best friend in natal care

It’s less than 10 weeks until Baby Devins arrives and I’m almost ready. We have a place for the baby to sleep, a pram for neighbourhood strolls and wee outfits generously gifted from friends and family (with a few we couldn’t resist buying ourselves). But in Germany, there’s another thing parents-to be must do – find a Hebamme, or midwife.

In North America, midwifery is coming back into fashion, but isn’t the norm. Some of my Canadian friends have used a doula for physical, emotional or spiritual support before and after the birth process. But doulas are rare in Germany where midwifery is the common practise - even hospitals keep them on staff. In fact, midwives run the birthing show in the German healthcare system.

Of the many things that make me glad to be having a baby in Germany, the extensive services extended to mums-to-be and new mums by midwives tops my list. Even better: It’s almost all covered by your insurance, whether you’re covered privately or publicly.

Prenatal care

In a previous column I wrote about my choice to see an OB/GYN for the duration of my pregnancy, but many women simply seek the services of a midwife for the routine pre-and postnatal check-ups. Not all Hebamme use the same medical equipment found in the doctor’s office, though, so parents need to decide what works best for them.

Most midwives work freelance. They usually have an in-home office or a Hebamme Praxis, where a group of midwives share an office and sometimes clients. Other midwives are employed in the birthing wards of hospitals, though they sometimes also take clients on a freelance basis.

Many midwives offer a pre-birthing class to impart delivery techniques and the basics of newborn care. Insurance will cover the fees for the mum-to-be's tuition, but dads may have to pay a partner fee.

Some also practise acupuncture, reflexology, homeopathy, aromatherapy and a host of other alternative therapies. These treatments are used to ease pregnancy aches and pains and prepare the body for birth. Acupuncture treatments, for example, are administered ahead of the due date to help the body cope with labour pains.

Birth

Perhaps the biggest choice for parents-to-be is whether they want to give birth at a hospital, birthing house or at home – because they’ll have to choose their Hebamme accordingly.

A regular Hebamme deals only with pre- and postnatal care, which deliveries will be supervised by whatever hospital or birthing centre midwife is on staff during labour. (Obstetricians are only called to attend births requiring surgery.)

A Beleghebamme, or “attending midwife,” will be with parents throughout the entire process, supervising pre- and postnatal care and delivery. These midwives usually have contracts with one or more birthing centres, which provides them with the insurance to legally deliver babies or specialize in home births.

But the Beleghebamme often have an on-call fee that insurance won’t cover, according to Sue Travis, a Berlin-based midwife who hails from Australia. In Berlin, it’s usually around €350, she says.

“For the weeks around your due date, even if she isn’t delivering your baby, the midwife’s life is disrupted. She can’t drink wine with dinner and she can’t go on holiday or even spend a day out of town in case she gets that call. The fee is just to make up for the inconvenience,” said Travis, adding that there are plenty of benefits that come with that fee.

“If you do seek the service of a Beleghebamme, they don’t just deliver the baby, but act as an advocate on your behalf at the hospital, making sure you have the kind of birth that you want,” she said.

Post-birth

After the baby is born, the relationship with the midwife remains important. During the postnatal period, or Wochenbettbetreuung, insurance will cover 26 visits or phone calls for up to eight weeks after the birth, Travis says. For the first 10 to 14 days after the birth, the midwife will visit every day. During these visits, she ensures both mother and baby are in good health and advises anxious new parents on feeding and other questions.

After this initial period, visits become less frequent, but that doesn’t mean the midwife will leave parents without assistance. “Most midwives should welcome phone calls to answer your questions,” Travis says.

Finally, when mothers adjust to life with their new baby, some midwives offer a fitness class to help get their body back to “normal,” called Rückbildungsgymnastik. (Finally the answer to how German women get back in shape so quickly after having a baby!) Babies are, of course, invited and incorporated into the class. Health insurance usually covers at least 10 hours of these courses.

Finding your midwife

All midwives in Germany have to go through a three-year training programme, usually based in a hospital. Others also seek education in alternative practises.

Most women start their search for a midwife at the beginning of their third trimester. If you decide on a Beleghebamme, start a few weeks earlier to ensure that you have some options. The number of midwives varies from region to region, so keep that in mind too.

One of the most common ways to find a midwife is simply asking friends for a recommendation. But know what kind of birthing experience your friend was looking for as she prepared for her baby. If you want a hospital birth with extensive pain relief options, but your friend went au naturale at a birthing house, her midwife might not be your best choice.

There are also midwife directories galore. German magazine Kidsgo has regional editions of its free quarterly magazine that can be found at OB/GYN and Hebamme offices. I also received a pamphlet with midwife listings from my OB/GYN. Or expecting mums can go to their local hospital for a list of midwives in their area.

Most listings include the midwife’s neighbourhood and the services she offers. Additionally – and perhaps most importantly for expats – they also note which languages she speaks. Take note of a few details and then pick up the phone to make some introductory appointments to get to know prospective midwives.

“The most important thing to look for is that you’re comfortable with her and you get along,” said Travis. “You’re going to get in some very intimate situations with her and you don’t want to feel shy about asking embarrassing questions about the state of your body after baby.”

When you meet with the midwife, Travis also suggests the following queries to help find a good fit:

• Her age and years of experience?

• Where did she receive her training?

• Where does she live, and which neighbourhoods does she service?

• How many women does she care for at any given time?

• How many other births does she have scheduled around your due date?

• What kind of services does she offer that may not have been in the listings?

• Which hospital or birthing house does she work at?

• How did she learn your native language?

• What are her opinions on pain-relief medications, induced labour and breast feeding?

In the end, your choice is as personal as your birthing experience, so it’s best to trust your gut to find a midwife that matches your preferences. My own experience taught me very quickly that most midwives are not at all shy about voicing their opinions on epidurals, the available clinics and breast feeding — but then again that’s something I’ve come to expect from all Germans.

Next month, Sabine Devins explores the different birthing locations available in Germany and what you should know about the options for delivering your baby.