Having a Baby in Germany
You'd think that something as basic as childbirth would be the same everywhere, right? Well, not quite. Here's what to expect in Germany.
If you are going to have a baby in Germany, congratulations! Although medical systems are quite different, the level of care is the same with all of the same diagnostic testing available. Many doctors speak English, though not all the staff at the hospitals do (e.g., midwives, or Hebammes).
In order to limit the number of unnecessary surprises before having your child, you might like to get a little extra background on the German system, terminology, etc. The doctors and midwives at the hospital of your choice can answer your questions and at the same time you can tour the hospital facilities.
You might like to do a little research on your own. In this case a very helpful publication is: Wo Bekomme Ich Mein Kind? This magazine can be purchased at any convenience/newspaper store or "Kiosk" or baby supply store. The publication contains lists of doctors, hospitals, maternity clothing stores and baby supply stores throughout Germany by region. The hospitals listed are described according to their specific facilities and amenities as well as all of the important related telephone numbers. If you feel that your German is not up to this task, you may want to devote a language tutoring session to going through this information. You will want to learn some of the vocabulary.
Some Pertinent Procedural Differences
One of the first differences that you may experience is the manner in which you and your doctor interact. Many have found that information that you are accustomed to receiving automatically may need to be requested. We are not sure if this is a cultural difference (i.e., in general, Americans expect to participate in medical care decisions more than their German counterparts), a language difference (i.e., since it is awkward communicating in a language other than our mother tongue, we tend to communicate less), a procedural difference (i.e., dosage information in the U.S. is provided by the doctor and in Germany it is provided at the Pharmacy or Apotheke) or a combination of all three.
Whatever the reason, you may need to stress to the doctor that you want to fully understand what choices are available and what risks are associated with them. Should this be perceived as questioning his/her judgment, you may find it helpful to remind the doctor/staff that German is not your first language and, therefore, may require more information from them than over native-speaking patients (e.g., dosage amounts, schedules, etc, that you may have difficulty reading in the pamphlets in medicine packages).
Secondly, you will find that holistic medicine (homeopathic) is more widely accepted in Germany and is endorsed by the medical community. You may have your doctor, midwife and other medical professionals recommending and performing acupuncture, acupressure and massage therapies for various medical conditions, especially during labor. Herbal teas and homeopathic medicines will be prescribed or recommended for you and your baby routinely instead of antibiotics.
Thirdly, pediatric medication is not always available in a liquid form. For example, analgesics for children are normally administered by suppository instead of in a liquid to be taken orally. Infant vitamins are in tablet form. Note that much of the tap water is not fluoridated so a fluoride tablet may be a good choice for your child while in Germany. If you use one of the boxed/bottled waters specifically for infant use, look to see if fluoride is one of the ingredients.
Choosing an OB/GYN (Frauenartz)
The first thing you need to do is find an OB/GYN. Keep in mind that the northern German medical system has a strict separation of responsibilities between hospitals and private practice and only hospital staff obstetricians are permitted to deliver babies. You may choose an OB/GYN that has a private practice and works outside of the hospital, or you may work with a doctor at the hospital where you will actually deliver your baby.
If you choose a doctor that does not work out of a Klinik at the Krankenhaus (hospital), he or she will not be the one to deliver your baby. He/she will perform all routine medical exams and oversee the pregnancy until labor begins, then the hospital of choice takes over.
Another option for an OB/GYN is working with the pediatric staff at the hospital. The head doctor (Chefarzt) usually oversees the entire pediatric department at the hospital. He/she is available to patients who are privately insured and because there are so few head doctors (usually one for the pediatric department) he or she will probably not be available to assist with the labor and delivery. However, the rest of the staff is trained to do exactly that and communicate with the Chefarzt frequently. One benefit of having your regular exams performed at the hospital is that it allows you to develop a rapport with the staff and you are better able to familiarize yourself with the hospital prior to giving birth. (See Choosing a Hospital.)
In Germany, the main responsibility for delivering your child rests with the midwife (Hebamme). You can choose a Hebamme in advance and she will work with you throughout your pregnancy and also be there to help with the delivery. Some Hebamme's are only "authorized" to work at certain hospitals, so you will want to know this when selecting a Hebamme and a hospital. If you do not choose a Hebamme in advance, the hospital provides one for you. (See Choosing a Midwife.) Your best source may be other women who have actually had a baby here.
Doctor's Examinations
In Germany, it is customary that a patient is not given an examination gown to put on before the doctor performs the examination. If this makes you uncomfortable, plan to wear a skirt, dress or long shirt that you can pull up as you lay on the table. Also, many doctors do not have a separate changing room to dress and undress, and they do not leave the room specifically to afford you some privacy (they may stay, come-and-go, etc.). In general, it is no problem to bring children with you to appointments. Some doctors allow them in the examining room with you and others may have a play area or room for them.
There are usually 12 examinations before the baby's due date (Termin Datum) - one per month until the 32nd week and then every two weeks thereafter. If you go past your due date, you may be required to go everyday or every other day. Ultrasounds/Sonograms or Ultraschallaufnahmen are not considered at all hazardous in Germany so you can expect these much more frequently. You may receive as many as six sonograms during a normal pregnancy as well as routine pelvic exams. During a routine exam the doctor will check your blood, blood pressure, urine and weight. The recommended weight gain per pregnancy is 10-11 kg (22-25 lbs). Near term, the baby's heart rate and any contractions are measured and this may take anywhere from 10 to 30 minutes, so allow extra time for these appointments.
The Mutterpass
After the pregnancy is confirmed, the doctor will have a booklet issued to you called a mother's pass (Mutterpass). It is essentially a passport to track the progress of your pregnancy and document all pertinent information such as the results of all tests and examinations made during your pregnancy. You will need to bring this to each examination as well as to the hospital. This is an especially important document since the doctor who will be performing your examinations will, most likely, not be the one delivering the baby. The person delivering your baby will need this information. It should be carried with you at all times during your pregnancy.
Choosing a Hospital (Krankenhaus)
This decision may be tied to choosing your doctor; if you want your OB to be at the delivery, then you need to choose one affiliated with a particular hospital. You will need to do this first. If you have chosen an OB who is in private practice, he/she is an excellent resource for hospital information and can help to arrange tours and appointments for you.
The hospitals hold regular information sessions (dates and times are usually posted in the hospitals, in the magazine Wo Bekommeich Mein Kind? and/or your doctor's office). If you feel that your German is not up to an information session, you may want to ask your language tutor if he/she will use a "lesson" to go with you. An appointment can be arranged for a private consultation and he/she can help you get a tour of the facilities by a Hebamme or nurse (Krankenschwester). It is also possible to arrange private Lamaze classes with your midwife. Your Hebamme may be willing to meet you in your own home or you can work with her at the hospital where you can actually see the facilities. It is important to take a tour of the hospital and familiarize yourself with the facility.
As you tour the facilities, keep in mind that not every hospital has birthing suites, chairs, tanks, etc., so look carefully. If there is something specific that is important to you, make sure you ask. Be aware that while all hospitals have some pediatric care facilities, not all have a full pediatric hospital (Kinderklinik). If the baby is born premature or needs extra care, your baby will be transferred to the nearest Kinderklinik and you will remain at the hospital where you gave birth. Therefore, you will be separated.
Regarding medication, each hospital may vary with what they provide and each midwife may vary in what she will allow you to have. Yes, some midwives have absolutely refused to give epidurals! If you know you will want an epidural, make sure you ask prior to ever going into labor!
Pre-Registration at the Hospital
Once you have chosen a hospital, you should register at the delivery room (Kreissaal) at the hospital. If you pre-register, the hospital will already have all the information they need i