Wednesday, June 01, 2005

Having a Baby in Germany
Labor and Delivery FAQ

What happened when you showed up at the hospital?
I was admitted by the doctor on duty, who happened to be the same one who gave us our tour last year. You might remember that, around here, the doctor who provides prenatal care doesn't usually work at the hospital, so I knew I would be cared for by doctors and midwives I'd never met before. Since my water had broken, I expected to hear that my delivery would happen one way or another within a certain time period (24 hours, I hoped). Instead, after saying, "Oh, yes, I think American hospitals usually have a time limit," she told us that I would begin receiving periodic doses of antibiotics if my labor continued past 18 hours or so, but without any kind of deadline for delivery.

Was the language barrier a problem?
Very few language issues arose. The doctors, who I almost never saw, all spoke English. There was always at least one midwife on duty during my labor who spoke English. Few nurses who cared for me after Theo was born spoke English, but we mimed our way through. I became braver and more assertive with my German than I ever have before, and put together an unembarrassed combination of simple sentences and charades that would have been high comedy if an outsider were watching. It struck me more than once how blunt I became, both because the communication style here is so straightforward but also because I only had a few words. If I had delivered in the USA, for example, I'm quite sure I would have had a subtler conversation than the one I conducted about having a "big toilet" or a "small toilet." Everyone at the hospital was tolerant and willing to participate in order to get the necessary message across.

What was it like working with both midwives and doctors?
While I felt I got good care from both, their approaches were very different. The labor midwives wanted to let things progress naturally. The doctors displayed a little more urgency, prescribing a cervical softener and trying to keep things on a schedule, but since the midwives were doing most of the care, I didn't feel like everyone was always on the same page.

I've heard that medical care in Germany is very homeopathic. Was medication an option?
In the discussions I had with doctors and midwives prior to Theo's birth, it was clear that I could opt for medication or not. I opted for a hospital birth and was open to pain medication and other drugs. If you are interested in unmedicated labor and delivery, home birth, etc, those practices are encouraged and accepted here as well.

When it came to my actual labor and delivery experience, I felt that the labor midwives were hesitant to offer meds. My labor was very slow, and I had to assert myself and ask specifically for pain relief, induction drugs, etc, some of which the doctors had prescribed but which didn't appear. In the days after Theo was born I heard of more than one mother, including one of my roommates, who went through five or six rounds of cervical softeners over two or three days before eventually getting a C-section. While I felt strange at the time demanding that my labor be artificially moved along, I was glad in the end that I forced the issue.

Did you have to share a room?
I was assigned to three different rooms during my stay, not including the delivery room. First, during labor, I was paired with a roommate who had been in the hospital off and on during her pregnancy due to required bed rest and what seemed to be a difficult living situation. Next, on the evening before Theo was born, I was moved into a room by myself (more on that later). Finally, after I delivered, I stayed in a room with a Scottish woman for the first few nights, followed briefly by a German teacher, both of whom were recovering from Ceasarean sections. We each had our own bathroom with a toilet and a sink. The shower was down the hall.

I was grateful that the nurses and midwives made an effort to pair me with English-speaking roommates. Rooming together was mostly comfortable, especially with my Scottish roommate who was friendly and had two other children. She had been in the hospital for a few days before I got there, so she knew the drill and could tell me where to find breakfast, what time the doctors usually came around, and how to turn on the reading light. Awkward situations arose, of course, including what to do with visitors and husbands during nursing/pumping. We soon got used to averting our eyes when the nurses and doctors arrived to perform examinations. The most difficult part was trying to get any kind of rest, since one person always seemed to be awake for feeding or comforting a baby. I would have preferred a private room, but sharing was better than I had anticipated, especially since I had a fairly uneventful stay. I got a taste of how difficult it might have been when my final roommate began to experience complications after her C-section the day I checked out. I'm sure the last thing she wanted was a cheery mother and baby across the room as she was hooked up to monitors, surrounded by doctors, and moaning.

Was Jeff allowed to stay with you?
Jeff stayed at the hospital with me throughout labor, but not without some resistance. One of the hardest moments during my labor came during the evening, when a midwife appeared and told Jeff he would have to go home for the night. My pain had just begun to intensify and Jeff was not about to leave. After a terse exchange, including my least favorite phrase in the world "that's not possible," and a lecture about how "In Germany, we do it this way," we paid the hospital 40 euros and Jeff was assigned a bed. The upside was that he became my roommate, and I didn't have to share with a stranger for the rest of my labor.

After Theo was born, Jeff stayed home at night. While I can see that the American practice of having the dad stay at the hospital would be great, it wasn't so bad to have him staying at our house, getting good rest. We both noticed very few men in the maternity ward at any time.

Did Theo stay in your room with you?
Most babies do room-in with their mothers. Moms could leave their babies in a nearby nursery if they wanted to shower or sleep. In our case, however, the doctors were extremely cautious in their care for Theo after his birth. He was kept in the KinderKlinik (pediatric unit) the entire time we were in the hospital, basically for observation of the bruise on his head and the danger of jaundice. After the first day, he likely could have been released without problem or watched and readmitted if jaundice appeared. I am a little regretful that he was never in my room with me, so that we could have gotten used to each other and had some instruction from the nurses. It removed some of the benefit of the longer hospital stay for me. This carefulness is a practice I've noticed throughout my medical experience here - extreme caution, lots of tests and multiple doctor visits for even the smallest ailment. In the end, though, I am grateful for the diligence of his doctors and the gentle pediatric nurses who took care of him while he was there.

Anything else you found interesting?
One night Jeff and I boarded the elevator with an elderly man dressed in a bathrobe, dragging an IV pole, carrying an open bottle of beer. Beer was also served in the cafeteria, and I was encouraged to drink Prosecco (Italian sparkling wine) or beer to increase my breast milk supply.

The baby Lo-jacks so evident at American hospitals were completely absent; in fact, none of us were even issued ID bracelets. A nametag on each isolette was the only form of identification used, and security was limited to a strongly enforced rule that babies could only exit their rooms inside their isolettes (ie no picking up your baby and carrying him down the hall).

What were the downsides?
As I expected, communication wasn't easy. I guess the final stages of delivery are always intense and somewhat chaotic. Add a language barrier to the equation and it confuses the situation even more. Until that point everyone had been great about either speaking English or translating, but the way things worked out, the team that delivered Theo included just one trainee midwife who spoke English, so there was a lot of interaction among the doctor and the other midwives that I didn't understand, which made me anxious.

The doctor-patient relationship here is usually one that assumes the caregiver is the authority and the patient should do whatever he says. That means that the idea of a birth plan was unfamiliar, and that my refusal to follow a few of the midwives' recommendations was met with surprise. The guy (nurse? doctor? janitor? he didn't say) who tried to inject something I later learned were antibiotics into my IV without telling me what they were wasn't very happy with me when I stopped him and asked for an explanation. The doctor removed my pain relief prior to delivery without much warning, and inferred that my baby would never be delivered unless she cranked the Pitocin up high and made sure I felt the full extent of every contraction. While this may have been true, it would have been better for my state of mind to have known it before it was underway.

What were the upsides?
All in all, our German hospital experience was positive. I am grateful to some wonderful midwives, doctors and nurses who competently cared for Theo and me while making a real effort to speak English or communicate in other, more creative ways. I had a nice long stay in the hospital (3 full days after delivery), which was especially good since we would have had to go home without Theo if I'd been discharged any earlier. You can't beat the price - the only bill we received was for Jeff's bed during my labor. The food wasn't bad and always included a nice breakfast buffet in the morning. And, of course, we came home with a happy, healthy baby. There's no better upside than that!