Last Updated on July 28, 2022
We continue the topic of pregnancy and childbirth. Now: What is hebamme and what is Mutterpass, what is written in Mutterpass. We will learn how to get a midwife and why you need one at all, and decide where to give birth.
In the first part there was infertility and miscarriage, in the second part – mandatory and additional tests, illnesses and inconveniences accompanying pregnancy.
Part 1 Infertility in Germany
Part 2 Pregnancy check ups in Germany
Part 4 Giving birth
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What is Mutterpass. Translating abbreviations from Mutterpass
Mutterpass is a document about your pregnancy in Germany. You need it every check up by doctor or hebamme. Usually the gynecologist does not tell you what he writes in the Mutterpass, so it makes sense to understand the abbreviations.
Gravidogramm (pregnancy records)
SW – Schwangerschaftwoche – week of pregnancy
Fundusstand – uterine height
Kindslage (position of the child):
Schädel-Lage = SL – head down
Becken-Endlage = BEL – seated head up
Querlage = QL – across, lying down
Herztone – baby’s heartbeat (normally between 120 and 160 per minute)
Ödeme – edema
Varikosis – Varicose
RR systolisch/diastolisc – blood pressure
Hb – hemoglobin (less than 12 – a reason to give vitamins)
Sediment – urine analysis for sugar, protein, nitrites (a sign of infection)
SSL – baby length
BPD – transverse measurement of the head
FOD – head in length
KU – head volume
ATD – transverse abdomen measurement
APD – measurement of the abdomen from front to back
AU – abdominal volume
FL – femur length
HL – humerus length
What is Hebamme
A midwife (Hebamme) in Germany is a jack of all trades: she accompanies before, during and after childbirth, checks the condition of the child, she is breastfeeding consultant, nutritionist, she makes massage and acupuncture. All this provided that you managed to catch her: Hebamme is not exactly an endangered animal, but an extremely scarce commodity in Germany.
There are several types of Hebamme:
– midwife working for a salary in the clinic
– a midwife without reference to the clinic (can offer various services: from courses to childbirth at home)
– Beleghebamme – a midwife who has a contract with the clinic/s and leads the entire pregnancy and childbirth (that is, who comes with the woman in childbirth to the hospital). Also, Beleghebamme can work constantly at the hospital and perform essentially the same duties as midwives for a salary. Some maternity hospitals do not have midwives for a salary at all, only Beleghebamme.
Why are they so scarce?
First, about a third of them have to pay personal liability insurance. If a child gets injured in childbirth, the parents’ insurance will deduct the amount for the treatment of this child from the Hebamme’s insurance (purely deal between insurances, as in a car accident). Since in the modern world people with disabilities live a long time and are expensive for insurance companies, this liability insurance has grown many times over the past 15 years and is about 8,000 euros, which is too much for many midwives.
Secondly, midwives for a salary are paid about the same as nurses, while having much more responsibility. This leads to the fact that many midwives retrain or leave the profession in the first years after graduation.
Third, the amount of working hours for the midwives was legally limited, which made them even more in short supply.
In order to improve the image of the profession and in order to bring the norms in line with European ones, a law was passed stating that Hebamme should receive education not at the level of Ausbildung (professional school), but at the level of the Studium (dual institute education). What can only be welcomed, the basic medical education of Hebamme is clearly lacking.
In the meantime, young women have just rushed to college to get this one of the oldest professions, you should take care to find Hebamme in advance – as soon as you find out about your pregnancy, especially if you want a complete set with courses and communication not only after childbirth, but also before it.
Do you need a Hebamme?
True, not everyone wants to have a Hebamme. I must say that there are very few midwives with whom personal contact (which is very important) and trust (which is even more important) is established. Often they are very fixated on some idea (usually “nature pur”, homeopathy and other internal forces of the body) and push it rather hard.
I remember how my first Hebamme, in general, was not bad, very much pushed the idea of swaddling children. Each time she showed me how great she swaddles a child and how he immediately becomes calm from this. She did this before leaving: as soon as the door slammed, the child pushed the hand up from under the swaddling-clothes – further release was a matter of one second.
Thus, if you adhere the same views, you will be comfortable, if not, you will have to endure the invasion of privacy for good purposes. But there may be also an extreme option, when the midwife adheres to the firm conviction “only natural childbirth”, but you actually want anesthesia and it happens in the hospital already during childbirth.
The main good purpose for which midwife is needed is to look after the baby after childbirth. Weight, jaundice, navel – this is what you want an experienced person to look after.
Hebamme for everyone
So if you haven’t found Hebamme before giving birth, there is another option: the open reception Offene Hebammensprechstunde. Such receptions began to be organized by public organizations and Gemeinde due to the situation with a shortage of midwives.
Once or twice a week, midwives receive pregnant women and those who have given birth, answer questions, and check their condition. Reception is paid by the Krankenkasse (therefore, you need to bring a insurance card, Mutterpass and a “yellow book” to the appointment). Some receptions are organized completely openly, without an appointment, others must be booked in advance.
Choosing a hospital
A woman can choose from three options:
- hospital birth
- in the “birth house” (Geburtshaus) – a praxis opened by the midwives, where pregnancy is monitored and mainly outpatient childbirth is carried out (4 hours after birth, the woman goes home)
- at home
For most, the choice consists of choosing between a large clinic and a small district hospital, the second and third options are exotic. I will only briefly mention them.
Childbirth not in the hospital
Childbirth outside the hospital (these are points two and three) is possible only for women with a well-proceeding pregnancy without any history of risks. Different studies show different results, but most of them are inclined to believe that the infant mortality rate of out-of-hospital births is higher than in the hospital, while the number of interventions in the natural process in the hospital is higher than outside (which is logical). Primiparas are at greater risk for out-of-hospital births and are more likely to be sent to hospital by midwives during childbirth.
A home birth requires a Hebamme, whose services include home birth. The costs in general are taken over by the Krankenkasse, but the period of “readiness for childbirth” (Rufbereitschaft) – the time when the Hebamme is always waiting and cannot provide other services, since it must be present at the birth – is paid by the family.
It is this Hebamme that decides whether a woman can give birth at home and bears legal responsibility for it. You can ask the doctor for advice, but he is not responsible for the decision. In theory, a woman can give birth alone, but then she can be held accountable if the child is injured.
“Birth houses” are not well received by the insurance offices and may have problems with reimbursement of expenses. It is clear that, like home birth, this is a “nature pur” option.
Birth in the hospital
And now to the more popular options. Most often there are two possibilities: 1) a clinic or a large hospital with a pediatric department and 2) several smaller hospitals with a maternity department, but no pediatric one.
The choice is determined unambiguously in favor of a large hospital with a pediatric department in the following cases:
– the pregnancy was difficult and there are concerns about childbirth
– it is assumed that the child will need help in the children’s department
– pre-term birth before 36 weeks of gestation
– multiple pregnancy
In general, the clinic is a kind of factory for all risky pregnancies. They are always ready for a cesarean section, they will easily give you anesthesia. But you will feel like on an assembly line and after childbirth the desired comfort may not be (like a single or family room).
If you want the most natural childbirth and comfortable days in the hospital after – you should think about the small hospital. Word of mouth usually votes for such small maternity hospitals. But if you are thinking about PDA or hope that if you feel really bad, they will somehow help you and alleviate your suffering – think strongly about whether you should not go to the clinic. Small hospitals do everything so that you do not receive anesthesia, and no one will seek to relieve your pain, unless they light scented candles and offer to swing on a ball – in such maternity hospitals, there is a different philosophy. See in the next part for anesthesia.
In hospitals, there can be different types of labor management, except for the classic:
– Hebammenkreißsaal – childbirth is carried out without a doctor, only with a midwife. That is, it’s like giving birth in a “birth house”, but with an increased level of security – the doctor is fully accessible outside the door. In Germany, this option is not as widespread as in other countries, but it is already found.
– Ambulante Geburt – after a normal birth, you go home in 4 hours. It is possible only on condition that you have a Hebamme that will be with you from the first day, and that the pediatrician already has a term. And of course, there are absolutely no complications during and after childbirth.
– water birth – advertised by all maternity hospitals, but real only when numerous conditions are met: the doctor is free and the Hebamme is free (and not five women in labor screaming at the same time at the stage of attempts in all the rooms), you are absolutely healthy and there are no even the slightest risks in your anamnesis, you do not claim any medications for pain.
Excursion to the maternity hospital
Almost all maternity hospitals hold lectures with a tour of the maternity department for parents-to-be once or twice a month. This provides a good opportunity to assess the level of the hospital. Just treat the listing of the services offered with a healthy dose of skepticism: not everything in reality can be as rosy as they promise.
In the maternity hospital, you can not only stare at the equipment if you have not seen it yet (in fact, it is enough to look at the brochures to get an impression) – it is about the same in all maternity hospitals. The main thing is to ask the questions that concern you: what does maternity hospital think about anesthesia, are they really ready to do it at any time, or do they not consider this method a good one? how real is a birth in the water, how much do they spend a year? How often is stimulation done in the hospital? what about cord blood collection? and so on. Already by the way a person responds, one can assess the attitude of the hospital to a particular problem.
Prenatal hospital visit
Many hospitals, especially in cases of high-risk pregnancies, want to see a pregnant woman before giving birth. For some reason, this is portrayed as a visit that the mother needs, but in reality this “acquaintance” is needed by the hospital itself – they include you in a conveyor belt convenient for them. A visit to the hospital is carried out by a term that must be taken in advance, as well as a recipe (Überweisung) from your doctor. An antenatal visit to the hospital is not a prerequisite for childbirth at that hospital.
This visit makes sense, if:
– you have a pregnancy with complications (including multiple pregnancies)
– you want anesthesia, but in this particular maternity hospital they want to arrange papers for anesthesiologists in advance
– want something out of the ordinary, like giving birth in the bathroom
– want to do another free ultrasound
In some cases, the gynecologist will require you to go to the hospital. But if this is not your case, then think hard about whether you need it.
If you do not agree with the opinion of the hospital doctor, for example, about stimulation, you will be subjected to strong psychological pressure. In this case, you will have to obey or be able to argue with them (it is very difficult when they start to scare you). If you trust your gynecologist, it is best to stay supervised in praxis and not spoil your nerves.