The midwife: Your best friend in natal care

Giving birth while living abroad can be a daunting prospect. The fifth instalment of The Local's series Motherhood in the Fatherland follows expectant mum Sabine Devins as she handles the cultural quirks of having a baby in Germany.

The midwife: Your best friend in natal care
Photo: Josh Devins

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.


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.


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.

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Immunisations and anal pharmacists

Motherhood in the Fatherland follows mum Sabine Devins as she navigates the cultural quirks of having a baby in Germany. In the latest instalment, she tackles immunisations and baby pharmaceuticals.

Immunisations and anal pharmacists
Photo: DPA

This month, my daughter reaches an important milestone: it’s her last round of immunizations until school age. It will be a relief for me to see her chubby little thighs bandage-free until she’s marching off to school with an overloaded Schultüte.

Luisa and her counterparts in North America and the UK are lucky to count going to the doctor as a fact of life. When a baby is born in Germany, he gets presented with a Babypass. Like my Mutterpass, the little book is a transportable medical file that mothers can take from doctor to doctor with her medical history. It also tracks baby’s development.

All of the check-ups, or Untersuchungen, are abbreviated to U1, U2, U3, etc. Luisa’s appointments are labelled on the front of her Kinderpass with what dates they should fall between, going all the way to April 2016. Each Untersuchung has a page for the doctor to fill out. It also leaves me with a handy little guide to how much Luisa has grown over the last year (it’s a lot!).

Most of the exams so far have been simple physicals. Making sure Luisa is growing properly and all her little parts with it. At the U3, there is an ultrasound to look for hip dysplasia — something that I find Germans to be disproportionately concerned with. As there is some hip joint issues in Luisa’s family medical history, she received an ultrasound at her U2, then again three weeks later, then with a specialist, and then again at the U3. The conclusion: “Her hips are just fine, we just like to be very careful when it comes to hip dysplasia,” said our doctor.

According to the International Hip Dysplasia Institute, hips that require treatment only occur in two to three children per 1,000.

What I do like about Germany’s scheduled medical care for babies is that they do immunizations a little later than in the English-speaking world. While Luisa’s friends in the US, the UK, and Canada all had their first round of shots at two months, Luisa didn’t get her first Impfungen until she was nearly four months. The first round is done in conjunction with the U4 check up, when Luisa is between two and four months old. Since her appointment was booked closer to the end of the fourth, that was simply when she got her first round.

As for the immunizations themselves, they are very much the same as what children in North America and the UK are given. Right now, Luisa has fighting power against tetanus, diphtheria, pertussis or whooping cough, polio, pneumococcus and hepatitis B. On the advice of my paediatrician, I skipped the Rotavirus immunisation and many German parents also leave out the Hepatitis B. After her last round, Luisa will also be armed against measles, mumps, and rubella.

Overall, there isn’t much difference between the care Luisa would get here versus there. But what is different in Germany is the at-home care and what Mamas keep in their at-home medical kit.

I’ve written before on the various uses of breast milk to cure these things, but that does come to an end and now those ailments lead me to the medicine cabinet.

For stuffed noses, we have saline solution. It’s hated by our little one and therefore seldom used. As Germany is the birthplace of homoeopathy, I can find all sorts of natural remedies. My favourite is called Osanit and they’re little pearls I use for teething pain. It’s main medicinal ingredient is chamomile. Whenever those gums start causing problems, babes are dosed with a few little pearls that they can roll around in their mouth and it seems to work. Life goes on. American mom Laurie has a similar product in her cabinet called Dentinox-Gel N, which also contains chamomile but in a gel format.

For those fevers, we use paracetamol, but its application is what makes our stash “very German”. The favoured method of dosing your child by the Mamas is Zäpfchen, or suppositories.

I wasn’t sure what to make the first time I realised what my doctor had prescribed after Luisa’s first round of immunizations in case of fever. But she was hot and miserable and so it happened and it was awful for everyone, but it did make her feel better. The next day I went to the pharmacy and asked for liquid paracetamol to give her instead.

The pharmacist was confused by my request. “But with the suppositories, you know she’s getting the right amount. You don’t have to worry about getting her to swallow it and once it’s done, it’s done,” she said, very pragmatically.

With the next fever, I took out a spoon and tried to get Luisa to swallow her medicine. It didn’t work. Her mouth clamped shut, she shook her head and sticky, orange-flavoured syrup got all over the floor. The practical German in me took over and we went back to the Zäpfchen. I’m now a convert.

I’m not the only one. British mum Tori told me she thinks they’re brilliant. “I would have never used them if I were raising Max [in England], but my husband, who is a doctor, was the one who stocked up the medicine shelf and at first I wasn’t so sure, but now they’re all I use.”

But others aren’t convinced.

When Laurie’s son has a fever, she uses liquid ibuprofen, which her pharmacist told her not to use until he was six months old. Before that, she had infant’s Advil and Triminic sent from the US. She also keeps American-bought Neosporin on hand. She also wishes that children’s acetaminophen were more available in the Fatherland.

English mum Susannah won’t touch the Zäpfchen. “Sticking things up a baby’s bum is not an idea I’d ever considered until I became a parent here. I would have no idea how to go about it, and would worry I was hurting her.”

Instead, she stocked up on the beloved English cure-all Calpol on her last trip home. “It’s poured liberally down English children’s throats from a very young age, whereas Germany seems less into plying babies with drugs,” she explained. “By extension, the German equivalents seemed less trustworthy in my mind: Irrational but true.”

She also has Calpol saline nose spray, as an assistant at her local pharmacy “raised her voice and eyebrows at my request for — what she called — a brutal product. She pretty much accused me of wanting to shoot drugs into my innocent child’s brain tissue.” But Susannah felt the German saline drops weren’t working and was delighted when she read “Suitable from birth” emblazoned on the English saline spray.

These days, we more readily turn to Google than our mothers to answer the million times we need to know: “Is this normal?” However, when it comes to comforts and cures, we turn back to what we know from childhood, whether it’s Laurie who goes for Neosporin to treat her son’s scrapes or Susannah who trusts one name to cure it all. Even if similar products are available in the German Apotheke, it’s just not the same as what we know.

And just because I use the Zäpfchen, doesn’t mean I wouldn’t be grateful for your tips on getting your babes to swallow their medicine.