Wednesday, January 16, 2013

Motherhood in the Fatherland

I totally stole the title of this post. Motherhood in the Fatherland was a column chronicling the cultural quirks of having a baby in Germany, written by Sabine, a Canadian also living here in Berlin who Tiffany met through other Canadians, and who it turns out is also the wife of a colleague of Sebastian's.

While I've long since ceased to be a German health care noob, I've never had a baby here (duh) or known that many people who have. Sabine's column had me laughing in agreement or provided useful maternity tips.

As an expecting mother I can choose to be seen by a midwife, an OB/GYN (a Frauenarzt) or a combination of the two. If I choose to have a midwife do all prenatal checkups I would still have seen a doctor for the three prescribed ultrasounds as well as a few other tests. I chose to see a midwife and my doctor in rotation.

The first midwife I interviewed asked if my gynecologist was from the east or the west. I live in the former East Berlin and there is apparently still an east/west medical divide, with older East German doctors being less open to working with midwives. I don't know how true this is, but my doctor is in the west and was completely supportive of working with a midwife.

I've been with my OB/GYN for 6 years now. Before staying with this doctor, who I see at least yearly, I saw two or three others. Here, it's typical to see your Frauenarzt instead of your GP for your yearly check-up. I like my Frauenärztin, she's professional, reassuring and practical. And yes, German gynecologists talk a lot during exams, some typical questions during pelvic exams:"is work stressful, what sort of contraception do you use". Also, no curtains or gowns.

Throughout my pregnancy I've received no dire warnings or strange restrictions from her or the midwife that made me doubt the quality or currentness of care.

German health insurance covers a wide range of midwife services: prenatal check-ups, a prenatal course, at-home postpartum check-ups, daily and then tapering off, as well as breast feeding consultations, and finally a Rückbildung course for getting your abdomen, uterus and pelvic floor back into shape. You are free to choose a midwife for any or all of these services. Midwives offer a wide range of services not covered by health insurance, such as baby massage courses, weening consultations and acupuncture. Acupuncture said to help ease and reduce the length of labour is very popular.

Sebastian and I attended a partner birthing course in our neighbourhood held by a local midwife. It was very informative, with detailed information about labour and birth, your pain control options, hospital processes, when to go to the hospital, other practical tips and included a special 10min dramatic enactment of escalating labour pains. Mostly it provided reassurance that birth is normal.

Women are free to choose to deliver at a hospital, a birthing house or at home. For the latter two, you need to be having an uncomplicated pregnancy and get your doctor's ok. Labour and birth are always attended by a midwife, even at the hospital and even if a doctor needs to be called for any complications, and not necessarily by the person who has been doing your prenatal care.  Nevertheless, the rate of C-sections in Germany is still going up. Birthing houses have been closing and the number of midwives doing home births has been going down, supposedly due to the increased cost of insurance. I haven't investigated the causes thoroughly.

Despite being attracted to the idea of a home birth, we've chosen to go to a local hospital where the whole range of maternity and neo-natal care is offered. Early on we heard about and decided to engage a Beleghebamme, a freelance midwife with a contract at a hospital for deliveries. The Beleghebamme does my prenatal and postpartum care as well as delivering me at the hospital. We pay an extra fee to have the midwife on-call for the last trimester. The midwife is specifically at the hospital for us, does not have to care for multiple women at time unlike the midwives on-call and we won't have to go through a shift change. We've had a good response from doctors (including the east-trained doctor who did our prenatal screening, belying the rumour) and other midwives when they've asked after our birth plans.

My midwife, like my doctor, is reassuring and practical and I feel in good hands.

Now, with my due date only days away, I wait.

A selection of Motherhood in the Fatherland articles:


Blogger Uwe Sauerland said...

Hey Kristin,

I didn't notice that you're pregnant until I read this blog today. My best wishes to you and your family. :)


1/16/2013 4:22 p.m.  
Anonymous Gina said...

Is there a breastfeeding support group in your area like the La Leche league? If so I highly recommend you join before giving birth!!!

1/16/2013 7:43 p.m.  

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