Saturday, November 06, 2010

Birth Around the World: Having a baby in Germany

I just discovered a fascinating (English-language) German newspaper series about Motherhood in the Fatherland. In The Local, Sabine Devins, a Canadian ex-pat and expectant mother, explains what it's like to have a baby in Germany.

The author's growing belly

The series has 6 parts:
Below are short excerpts from each.

"When you move into the examination room, there is probably some sort of screen for you to undress behind, but don't expect it to be private. If you've lived in Germany for awhile you'll know Germans aren't particularly shy about nudity. After disrobing, you walk over to the doctor's chair in all your glory. This can disturb some expats on their first trip to a German obstetrician. Unlike a visit at home, I was not shielded from the sight of the examination by a paper towel. I sat in a chair and the exam began. Oh right. The chair.

"While there is an examination table in most offices, for some visits you're in a chair specially designed for gynaecological purposes. You sit down and recline, but you're still face-to-face with the doctor, while all of those medical instruments remain in plain view. As is what he or she is doing down there. Oh — and German doctors seem to like to make conversation."

"If I were back home in Canada, I’d probably walk into a pharmacy and purchase a suitable medication thought safe for pregnant women. But in Germany doctors and chemists encourage a more natural remedy. Yes, to cure what ails during pregnancy, there's a tea for that.

"'It's a tea-drinking culture here,' the pharmacist at my local Apotheke explained. 'It’s very old, dating back to when monasteries were also healing places for the sick, and now it’s practically a tradition to turn to tea first.'...

"After discussing digestive issues with my obstetrician-gynaecologist, she wrote me a prescription, but told me to try fennel tea, or Fencheltee, first. I have yet to fill the prescription and will probably stick to the tea.

"Against the leg cramps that I'm waiting to start any day now, I'm to drink chamomile tea, or Kamillentee. To combat the increased mucous my body produces ('A totally normal thing,' says my doctor), I drink the occasional cup of thyme tea, or Thymiantee.

"There is even an herbal tea mixed specifically for pregnant women, appropriately called Schwangerschaftstee, or “pregnancy tea.” I got my leafy mixture at my local Apotheke, where the pharmacist explained that the particular brand, mixed by Bahnhof Apotheke, came highly recommended by Ingeborg Stadelmann, midwife and author of a well-known German guide to pregnancy. You can also find the tea at organic grocery shops and local drug stores."

"When Baby is born, residents must head down to their local Standesamt (civil registry office) to officially register the vital details of their new addition. There German parents find themselves at the mercy of bureaucrats who decide whether the name they put on the birth certificate will get the stamp of approval.

"Many of my Canadian friends are choosing gender-twisting names like 'Charlie' or 'Devon' for girls. But here in Germany, if a name does not properly reflect the baby’s gender, parents had better have a feminine name that lends itself to a gender-bending nickname to put down on the books instead.

"Also verboten are names that could cause future humiliation to the child. Along the same lines, babies cannot be named after corporations, though I did recently overhear a new mother introduce her daughter Nike in my OB/GYN’s office. Apparently the bureaucrats will make an exception for babies named after a Greek goddess who also happens to represent a sports equipment company."

"Here in the Fatherland, it's bad luck to celebrate an event before it happens, especially a birth.

"While North American mothers would begin receiving gifts a few weeks before their due date, German friends and family won’t bring presents until after the newborn arrives. I have yet to encounter a shop that offers gift registries for mothers-to-be planning a baby shower. It's just not done here.

"That's why my Oma Eva was horrified when I told her my Vancouver family members wanted to host a little baby shower when we visited in July. 'You can't do that!' she yelled into the phone. 'It's bad luck!'"

"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....

"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

"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...

"A regular Hebamme deals only with pre- and postnatal care; [the] 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....

"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."

"In Germany there are three options: hospitals, birthing houses, or at-home births....Similar to my midwife search strategy, I got a plethora of literature about where to deliver in Berlin. It included hospital and birthing house locations, whether they employ Beleghebammen, or attending midwives, and when they host information evenings for expecting parents...

"While [hospital] delivery rooms are almost all equipped with the traditional hospital bed, many also have an alternative available to aid in more comfortable labour. I've seen delivery rooms with big jacuzzi tubs for water births, a king-sized bed allowing dads to take an active role in the delivery, birthing stools and chairs, and a curious round bed that supports a host of delivery positions....

"If I didn't want a hospital birth, I could have just as easily choose a birth house, or Geburtshaus, for a 'home away from home' setting. For many people, a birth house is a compromise between a home birth and hospital.

"These facilities offer a more intimate and private environment for the delivering mother. The births are attended by a midwife and the delivery rooms are cosily furnished for a homey feel, with a few extra tools to help with delivery. As with some hospital rooms, birthing houses are often also equipped with big tubs for delivery, or just helping women relax during the process. Mothers can also choose birth stools, various positions in bed and using other specialised equipment to help them deliver as comfortably as possible.

"Birthing houses intend for women there to have natural births, so they are less likely to administer Pitocin and they don’t do epidurals. There is also no option to overnight at a birth house. Women who deliver at birth houses do so only on an outpatient basis...

"Home births are also an option in Germany and, like hospital and birth-house deliveries, are covered by medical insurance....Not all midwives attend home births, so it may take some time to find one. Mothers who want a home birth can also find a midwife practise or birth house that has the insurance to deliver in-home...

"Women who plan on a home birth will have to do a little more preparation, as they'll be expected to have all non-medical supplies on hand. Most midwives have their own foetal heart rate monitors and basic medical kits containing clamps for the umbilical cord and stitches, but they will expect parents to gather a checklist of other supplies."


  1. The bit about the evil eye and bad luck is familiar. Jewish families, or at least Ashkenazi - German and Eastern European - Jewish families traditionally do not/did not do baby showers, prepare the baby's room, or publicly discuss baby names before the arrival of the baby. I had always thought of it as a Jewish thing, but maybe it was just part of the general culture in which those Jews lived.

    Also, Ashkenazi Jews do not name babies after living relatives, lest Death get confused when it comes for the older person and accidentally take the baby.

  2. This sounds like a great system, over all!

    As a homeschooling natural birther, though, I find myself thinking, "You win some, you lose some," depending on the culture in which you live, since Germany is VERY ANTI-homeschooling.

  3. Baby showers are not common where I'm from, either (Ireland). It's regarded as a very American thing, and quite tacky. People also don't give presents til after the baby is born - bad luck.

    Would *love* a system like Germany's. Here there is hospital or home, and home is threatened at the moment.

  4. Hmm...19 weeks to go. I wonder if that's enough time to move to Germany!

  5. No way, man.

    First of all, vaginal exams aren't necessary in healthy low risk births. I haven't had a single one this pregnancy. I'm 39 weeks and everyone keeps asking me if I'm dilated or effaced. What a rude question! And, I don't know and don't care, and neither does my midwife. The baby will come when she comes, and introducing a bunch of bacteria into my vagina isn't going to help anyone.

    Secondly, the ultrasounds! I had one, and I spent a long time considering whether or not to have it at all.

    It's hard for me not to make a rude comment about Germany's tendency towards medical experimentation throughout history, particularly when ultrasound is often referred to as the largest medical experiment humankind has ever seen....

  6. I have to agree that this fascination with knowing--and asking random pregnant women about!--the state of the cervix is really kind of weird. Your dilation & effacement don't predict when labor will begin or even how long it will be. All the measurements tell you is what is going on right now--not what will happen tomorrow or next week. Or even in the next hour.

  7. I had a great pregnancy and birth experience in Germany with my first daughter. I am pregnant with the second now. The systems are a bit different state to state in Germany. I live in Bavaria where there are no birth centers, and in the town I live, there is only one midwife who does home births. Most women seem to chose hospital births here, so I have been able to book her for the second.

    I also found that the type of care you get can vary greatly even from hospital to hospital. I had a natural breech birth in one hospital, but any other hospital in town would have pushed for a c-section. Only the hospital we chose specialized in vaginal breech deliveries, and much of that was due to a team of midwives who have been able to work with the doctors to keep there hands off of the breech deliveries.

    The open nudity and the 'chair of exposure' are exactly the same in Bavaria! When I was back in the US a few years ago and went to an OB, I kept taking off my clothes at the wrong time because I didn't wait to the doc to leave the room! I guess I got used to just stripping down in the middle of the room.

  8. I delivered my second in a German hospital in 2008 and next to a birthing at home, it was the best experience I could ask for. My favorite things were the support for birthing in the tub, no doctor in attenance and the midwife post natal visits in my HOME. She came 6 times every couple days(its all my American insurance would cover)and it was such a comfort to me in those early days. It was such an amazing experience, all of it. But his time around, now that we're back in the states, we're looking forward to a birth at home.

  9. After reading the articles you linked to, I think it is worth saying that one thing I found really impressive about the system here is that my choices about my prenatal care and birthing have been respected by the doctors and midwives I've worked with.

    I had a lot of fear in my mind because I had a strong desire for a natural birth experience and had read so many stories of women being coerced by the medical community (usually stories written by people in the US). Given that my daughter was breech, I felt that I would be under more pressure to have interventions.

    However, I made my desire for a natural birth very clear to my doctors and midwives, and they were all supportive. I was presented with the information I needed to make choices about things like possibly having an attempt at an external rotation of the baby (we opted out of that), but my doctor did not push at all and made sure we understood the potential risks from the procedure. In the end, we tried some alternative, non-invasive methods like acupuncture and Moxin. Even the doctor at the hospital who I expected to put some kind of pressure on for a c-section said she didn't see any reason why we couldn't do a vaginal delivery. I also requested that I not be hooked up to an IV during labor, and there were no restrictions placed upon me regarding food or drinks. I was active the entire labor and never left the room where I eventually delivered.

    The midwives were happy to support my labor if I needed it, and a doctor was present for the birth (a protocol for breech deliveries), but she simply sat back with her hands folded and watched me deliver while the midwives were by my side. I delivered on hands and knees; no one touched my daughter, and after she was born, I was the first person to touch her. I held her for quite some time before the midwife asked to take her across the room for a brief exam (assisted by the new daddy). We went home together 4 hours later by our own choice. The midwife was by later that day to check on us and came by every day for a little over a week to help with nursing issues and check on my body.

    This experience me not be the norm here, but I appreciated that my choices were supported (and covered by my insurance without question). Most of my friends here have had much more medical intervention in hospital births here and stayed at least one night, but that was also their choice.

    This pregnancy, my doctor knows I am planning a home birth, and though most of her patients don't chose this option, she was completely supportive. Likewise, my midwife (who often does all of the prenatal care for her clients) has not shamed me for also wanting prenatal care by a standard OB and the ultrasounds and other medical interventions that come with it. I meet with both of them at the moment and am very happy with the care.

  10. I live in Germany, and I have had experience with "the chair" however, my doctor gave me a robe to put on, as well as a paper sheet. Also, my german friends have already encouraged me in baby shopping. Those are the only differences I've noticed between your story and mine. And yes I've had the 'natural' remedies. Kamille Tee, Honig, etc... The prenatal vitamins here are MUCH easier on my stomach!

  11. I don't know if my comment posted...however, I live in Germany (Bayern) and I have to say, I have had experience with the natural remedies, which I really like. Kamille Tee, Honig, etc. I love the german prenatal vitamins. They are VERY easy on my stomach. As far as the nudity, my OB always gives me a robe and a paper sheet. And they have a little boxy area with a curtain in which to put the robe on.


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