Friday, September 15, 2006

Having a Baby in Germany
Part One: The Nuts and Bolts of the First Half of Pregnancy

I'm just rounding the bend of week 22 in my pregnancy which, for the uninitiated, means I'm a little over halfway through growing my very own human being. For this first entry, I've recorded some quick hits on topics that struck me as relevant. The following should catch you up on the nuts and bolts of the journey that Jeff, Junior, and I have taken so far:

Choosing my Doctor
I chose my OB/GYN based on a recommendation from our relocation consultant. I was looking for someone who a)accepted the public health insurance (see "Insurance" below), b) speaks English, and c) had an office that was accessible to me without a car, if possible. I wanted to keep my pregnancy private for a while, so I was hesitant to ask other English-speaking acquaintances that I'd met through Jeff's work or my German courses, but this might have been a good avenue as well.

I see the doctor every four weeks until I near the end of my pregnancy, when I will see her more frequently. This is about what I expected. My doctor's office has been very efficient - I've never had to wait more than 30 minutes to see my doctor. This seems to be unusual; even with an appointment, it seems that the system here requires most patients to expect a long wait before seeing a physician.

I use the German public health insurance (both private and public insurance are available here, and the number of people eschewing the public system for private providers is increasing). At my first appointment, I handed over my insurance card, expecting to be met with a handful of forms. Magically, when my card was swiped through a magnetic reader, my identifying information and the medical history I'd provided when I registered with the insurance company appeared on the receptionist's computer screen. I've had good luck with the public system, though I know there are some providers who accept only private insurance. Public insurance will not cover a private room when I deliver. Coming from the USA and the mess that is the health care system there, it's hard to complain (though I'm sure I may utter a few unkind words if I end up with multiple roommates in various stages of labor). The system here isn't perfect (My dental exam was covered, for example, but I had to pay out of pocket to have my teeth cleaned) but at least every person who lives in Germany is required by law to have coverage.

I received a Mutterpass ("Mother Passport") at my first prenatal appointment. It's a standard form used, as far as I can tell, by all doctors throughout Germany. My doctor fills out a section of it at each of my appointments, including vital stats, blood and urine test results, and the results of any other testing or recommendations that I've received. A short version of my medical history is in there too. I was advised to keep the Mutterpass with me at all times, so that if I have a medical emergency or need to see a physician when I am away from home, I'll have this information handy.

Prenatal Testing
I have received most of the prenatal testing I expected based on friends' anecdotes and on my own research. My doctor doesn't seem to be an advocate of extra tests - in the USA, for example, I may have been more strongly encouraged toward an amniocentesis due to my age, but she steered me toward the more thorough ultrasound along with blood tests to check for indicators, then allowed us to make the call on the amnio once the results came back with low odds for Down Syndrome, Trisomy 30 and Trisomy 80.

I've had five prenatal appointments, and an ultrasound has been performed at four of them. This was a pleasant surprise, since I know that many American moms must wait until the twenty week mark to see an ultrasound, and must do so at a time and location outside their normal prenatal appointments. My OB/GYN has performed all my ultrasounds in her office; in fact, both exam rooms I've seen there are equipped with their own ultrasound machines. The purpose each ultrasound:
-1st one (6 weeks) - confirm pregnancy
-2nd one (10 weeks) - set due date
-3rd one (14 weeks) - optional test for indicators that an amniocentesis may be necessary (We chose to do this because I am of "advanced maternal age.")
-4th one (22 weeks) - 20-week ultrasound to take measurements and confirm that all is progressing as it should be
I will have one more ultrasound as part of the normal prenatal series, at 30 weeks. Three of the four ultrasounds I've had so far, along with the 30-week ultrasound, are included in my health care plan, and if my doctor decides she needs to do more based on symptomataic or test indicators, those will be covered too. The third ultrasound was optional, and cost us 50 euros. If I want more (for, as my doctor calls it, "baby viewing"), I can pay extra - 25 euros per extra ultrasound or a flat fee of 90 euros if I want one at every appointment.

Bedside Manner
This is, of course, a highly subjective topic and varies greatly from doctor to doctor. Since Jeff and I have both had several different experiences with healthcare providers in the past year (different kinds of physicians, dentists, etc), we did draw a few conclusions about cultural differences between the bedside manners of German doctors versus what we're used to in the USA. As Americans, we are used to being treated as consumers in the medical world, due to a customer-service oriented culture and the competitiveness the currently exists in the American health care industry. My American practitioners sat down after my annual exams and gave me carte blanche to ask about any ache, pain, or weird bump on the top of my head that might be bothering me. I had always imagined the first doctor's appointment of my pregnancy to be an opportunity for information-gathering. I'd heard about the questionnaires, the photocopied lists of recommended dietary precautions, and the urgency with which I would be encouraged to sign up for a prenatal instruction course.

My German OB/GYN has been friendly, helpful, and more than willing to speak English with me. She seems competent and knowledgeable, and I trust the care I have received so far. I was surprised, however, when she seemed brusque and breezed quickly in and out of my appointments. She usually stands up after she finishes my exam, shakes my hand, and starts to leave the room before I stop her with my list of questions. Sometimes she answers my questions - other times she tells me to refer to my Mutterpass (see above), or (very occasionally) tells me that I really don't need to know that information yet. I have never been given advice about diet, exercise, or health habits. I've never been asked if I am a smoker, or told not to empty the cat's litter box. I imagine there are several reasons for this, and the language barrier is probably a big one. Her English is good, but not fluent, and my German is elementary at best; if she routinely provides questionnaires or handouts to her patients, they are probably printed in German. I would bet, however, that it is more attributable to a cultural difference. I am expected to take responsibility for my own health, and to read and learn about what is best for me. There is something empowering about this philosophy that I like, though it requires more effort and different expectations from me. I've also found that, when dealing with a professional in any field (real estate agent, carpenter, insurance broker), we have been required to ask very specifically for the information we wanted - there are no long explanations or words of advice followed by, "any questions?"

Next time
The final explanation for my doctor's brusque manner is, I think, due to the pivotal role that the midwife usually plays in prenatal care and childbirth here. Midwives and physicians work together with expectant mothers - most women here use both. Jeff and I have scheduled meetings with prospective midwives in the coming weeks, so next time I'll write more about the role of my midwife.

Introduction and Disclaimer


EuroTrippen said...

Well you've read about my recent experiences with doctors, hospitals & barked orders... I feel your pain. The nice thing, though, was I never felt the science or technology lagged behind. I guess at the end of the day that means more to me than a pleasant bedside manner.

I'm looking forward to reading along as you go through the odyssey that is motherhood. I haven't had a baby in germany, but I've got plenty of experience with pregnancy, labor (both medicated & natural... I advocate medicated) and child rearing. I'm also just an email away should you need to talk or vent!

Anonymous said...

Shalimar says her doctor doesn't tell her anything here in the U.S. either. Doctor will answer questions, but appears to think we should just know everything.

Isn't it fun being of "advanced maternal age?" Here its just called