July 01, 2011
Midwifery in Germany differs in many details from the situation as it is in the United States. Sure, on both sides of the ocean mothers and fathers wish nothing but the best for the newborn life, but the way to achieve this may be somewhat different. This article focuses on midwife education in Germany pointing out the importance of freelancers in this area.
Midwifery in Germany is a health care profession which takes care of women in pregnancy, labor, birth and postpartum. There are circa 18,000 midwives in Germany who have passed their exam at one of the total of 58 schools of midwifery existing here. As for the foreign midwives from all over the world that wish to work in Germany, they may have to visit one of the German schools of midwifery so as to improve their theoretical knowledge and gain further practical experience. The training there consists of about 1,600 hours in theory and circa 3,000 hours in practice. In order to provide a deep insight into the variety of obstetrics, the schools are collaborating with various hospitals located in all of the 16 states in Germany.
The smaller hospitals with 300 to 700 births per year are often run by midwives with hospital affiliation, meaning they aren’t employed by the hospitals but work freelance. Hence, they have to insure themselves and settle up with the health insurances on their own. Since these hospitals often lack in their own pediatric sections, the medical check-ups post-birth are done by residential pediatricians. In case, a child needs pediatric help, it will be transported to the nearest pediatric clinic. However, in these little hospitals the obstetrics taking place often is kind of out-of-the-ordinary due to the lack of their own pediatric section. Normally, these hospitals would only survey low-risk pregnancies. Nevertheless, the bigger hospitals among them, University clinics, do have their own pediatric sections with neonatal intensive care units allowing them to take care of high-risk patients. Therefore, the obstetrics there has a much more medical approach and the midwives are also employees of the hospital they work in. Not only are they insured by the hospitals, but also all money issues concerning birth and care are settled up between the clinics and the health insurances directly.
In addition, several hospitals in Germany also offer special rooms where only midwives are in charge, besides the normal delivery rooms. This shall enable a natural sense of birth without any intervention from outside, if possible. Medical help being within shouting distance, the pregnant women there are able to give birth to a child in a secure and intimate environment, knowing that a medical team is at their disposal, if needed.
During her education, the midwife-to-be is given time to explore deeper insights in the work of freelancer midwives. It is, for example, quite common that several midwives would join together and rent a room or flat to offer their service. These places normally consist of course rooms for antenatal preparation, exercises and regression, rooms for pregnancy check-ups and care and, of course, the comfortably furnished birth rooms. Thus, the midwives can offer the complete range of services in pregnancy, during birth and postpartum. Let’s mention here that a birth in Germany has to always be surveyed by at least a midwife, but not necessarily by a doctor. You will find midwives supporting each other – and the mother, sure – during the second stage of labor. Then, only if medical help is needed, the mother would be transferred to a hospital nearby. It is even possible, and a much requested option by the way, to give birth to your child in your own house or flat. This is financed by the health insurances as well.
To sum it up, one can say that, during her three years of training, the midwife will get to know the complete spectrum of obstetrics with numerous pathologies and operations. Once having passed the exam, it’s up to oneself to decide where and how to work. You can offer your service everywhere in Germany, and either work as a freelancer, or seek a hospital for employment.
The midwifery schools in Germany are administrated by a midwifery teacher and a doctor. This ensures the high-quality standard of the education needed. The educational background is specified in the Training and Examination Regulation for Midwifery and Obstetric Nurse (HebAPrv) and the European Union 2005/ 36/ EC. Both, the theoretical and the practical lessons, take place in the midwifery school and are held by various experts, such as, not only midwifery teachers and doctors, but also biologists, pharmacologists, nutritionists and psychologists. The state-run final exam concluding the three years of education comprises three parts, a written one, an oral one and a practical one. The latter one consists of a complete and independent care and management of a birth in hospital with a following care postpartum. The main aim here is the examination and observation of the newborn, the instruction of care and the handling and care of the mother. Every action has to be documented explicitly. The range of marks applied is similar to the German marks in school, meaning a “1” (very good) is the best and a “6” (“unsatisfactory”) the worst mark possible. To pass the exam, however, at least a “4” (“sufficient”) in each part is mandatory. The new midwife then gets her certificate and the right to use the official term “midwife” from the local public health department. In case of failure, each step of the final exam may be repeated just once more.
So, now the new midwife works either freelance or is employed by a hospital. But when, actually, is she contacted? Short answer: In many cases, already before a woman wants to become pregnant. Many things have to be decided: Who shall do the pregnancy check-up, the midwife, the doctor or both together? Where shall it happen, at a midwife praxis, the birthplace or at home? No need to see the doctor this early, except for the three obligatory ultrasounds.
Most pregnant women in Germany decide to visit the antenatal class from the 25th gestational week on, partly with her partner, to prepare for birth. The midwife’s task here is to support the mother-to-be during pregnancy, especially when premature labors occur. This is a service offered by the health insurances. After birth, all mothers have a midwife for the aftercare. If it wasn’t an ambulant birth, the women stay in hospital for one up to five days and may then return home. There, the helping hand of a midwife is, of course, very much appreciated, be it for breastfeeding advice, be it for questions concerning family life in general.
Beyond that, a lot of midwives offer course lessons after birth with a huge range to choose from: baby massages, courses for regression, groups for breastfeeding mothers, children playgroups or yoga to name just the most common ones. Since the importance of carrying a child correctly has finally been recognized, there are also courses available that teach one how to carry a child in anatomically correct positions. Not only sheer practical reasons make the parents ask for help in this question, but also the fact that carrying your child increases the emotional tie. Given the number of baby slings and carriers on the market, a midwife’s help is often needed to make the right choice. Thus, many midwives have absolved any extra education in this field to become specialists themselves, for they know: You should carry your child – not only to full term.