Tuesday, November 07, 2006

Having a Baby in Germany
Part Two: Care Providers and Hospitals

We're at week 30 - just 25% of my pregnancy left. So you probably assume that Jeff and I have concrete plans in place regarding who, where, and how our baby will be delivered. I put off writing this entry until we'd figured out all of those details but, like everything in our lives here, it seems that these decisions take three times as long as we think they should. We've met with three midwives and toured one hospital in the past month. Though we haven't finalized our choice of personnel or location yet, I feel like I have a much better handle on how the German system works when it comes to people (what I imagined to be midwives, physicians, nurses, lactation consultants, doulas, etc) and care facilities.

Finding a Midwife and a Hospital
I started my midwife search by asking my doctor, who gave me one name, of a midwife who is very kind and competent but who said she didn't feel comfortable working with me because of her limited English skills. I then asked another American woman who had recently given birth. She asked her midwife for referrals, and by making a bunch of phone calls and emails, I'm finally homing in on a final choice. My most important criteria include competence (duh), English skills, and willingness to listen to my preferences.

We've toured one hospital and will probably tour one more before we make our final decision. We've received very different responses as we've called around to try to arrange tours. The staff at the hospital we've already toured was extremely helpful, even arranging for a doctor to give us a private tour in English. At another hospital, I was met with a brick wall when I asked if I could call in advance to find out when the regularly-scheduled tour might be offered by a guide who spoke a little English. Of course, you can probably guess which hospital is ten minutes from our house and which is a 30-minute drive away. Fortunately, we've received good reviews of the medical care offered by all the facilities in the area. I am nervous about my ability communicate in either German or English with the hospital staff no matter where we go. I know from experience that most doctors speak near fluent English, but as you'll read below, it's the midwives that matter more.

NOTE ABOUT LANGUAGE: I realize that it might seem like I'm obsessed with the English skills of my care providers, which I know is unfair. I am in Germany, after all, where the language is, um, German. Don't imagine that I don't realize how lucky I am that my native language is emphasized in the school system here, and that I have the option of being picky on this matter. In reality, though, communication is extremely important to me in this process, and the likelihood of my German improving enough in the next ten weeks to include any kind of medical terminology is zero. So I'm at the mercy of the kind English-speaking medical community in my area, and so far I've been very lucky.

Midwives - Prenatal Care
German midwives play a prominent role at almost every stage of the game. Some women see an OB/GYN for their prenatal care, but others do all prenatal care with a midwife unless complications arise. Others see them in tandem - doctor one month, midwife the next. Midwives have the equipment and training to do basic prenatal checks, including checking fetal heartbeat, position, lab work, etc. They do not offer ultrasounds. Some midwives work out of private practices, others are part of a Geburtshaus (Birth House - more on that later), and others work exclusively in hospitals. Prenatal classes are generally run by midwives. I chose to see an OB/GYN for the majority of my prenatal care simply because that's what I was used to, and due to my age I probably would have been sent to one anyway for extra checks, ultrasounds, etc. It looks like we'll work with a midwife to do some kind of private instruction along with one or two prenatal visits instead of attending a birthing class. This is a little disappointing for both of Jeff and me, since it would be nice to meet some other expectant couples, but all of the midwives we've met with told us that the courses are conducted completely in German, and we wouldn't really get much out of them.

Midwives - During Birth
Midwives run the show during birth, unless serious complications arise. I have the option of giving birth at home (um, not for me), in a Geburtshaus, or at a hospital. Midwives are on hand in all these situations. About 5 percent of women in Germany have their babies outside a hospital. Home births have become less common over the years, though it is not uncommon for a midwife to assist a woman who prefers to labor at home, and then send her to the hospital as birth becomes imminent. Most towns have a Geburtshaus, which hosts a group of midwives and a "homier" but still medically-equipped (though not fully anesthesia-equipped) environment where women have their babies, then depart for home within hours. My choice, and the choice of 95% of women in this country, is to give birth at a hospital. Hospitals have staffs of numerous midwives and a handful of doctors on their labor and delivery wards. Midwives staff most aspects of L&D, delivering babies and handling patient care. Nurses take over after the baby is born.

Doctors - During Birth
One of the biggest surprises for me was learning that my regular doctor will definitely not deliver my baby. It is unlikely that I'll see my regular midwife either, unless I choose a (rare) midwife that maintains a prenatal practice as well as a position at the hospital, and that she happens to be on duty at the crucial moment. The hospital staff of doctors and midwives is quite separate from the medical practice outside the hospital.

At the Hospital
Most of my friends in the US stayed in a combo delivery/patient room when they had their babies. The rooms were large and private, with a couch or recliner where Dad could sleep. German hospitals are set up more traditionally, with delivery rooms for women in active labor. Some are equipped with tubs for water birth, and all the pain relief options I've read about and heard about seem to be available. After the baby is born, Mom & baby move to a patient room. All patient rooms in the hospital we toured are doubles - two beds for two moms - with no sleeping facilities for Dad. If the ward is not crowded, however, Dad is allowed to stay in the room and sleep in the second bed. Most families stay at the hospital for 3 days so that the baby's first pediatric check-up can be done before they go home. We will have the option of leaving earlier if all goes well. I've heard that the length of hospital stay is directly affected by the existence, volume, and family size of a roommate. Jeff is concerned mainly about the quality of the cafeteria food.

Midwives - Postnatal Care
Our midwife will visit us at home after the baby is born. She (I've never heard of a male midwife here) will come to the house regularly (daily for the first week if I choose) to help with nursing, check my physical and mental state (yikes) and to check on the baby. The frequency and duration of her visits is up for negotiation, so if I need more or less help, I can ask for it. This seems like a wonderful idea, especially since I'm planning to attempt to nurse, and I know I'll probably use all the help I can get. I imagine these visits will also ease the panicked feeling I inevitably will have when I am sent home with a tiny baby, no close friends or family nearby, and no clue how to take care of him.

All of the above is covered by the public health insurance system, including prenatal instruction and postnatal home visits.

Odds and Ends
If I had it to do over, I would have gotten serious about searching for a midwife much earlier in my pregnancy, mainly due to my (probably excessive) desire for advance information. It's been such a relief to sit down with a midwife and have time to get the answers we've wanted for so many weeks (like all the info above). I am much less nervous now that I know vaguely who is responsible for what, I'm familiar with my pain relief options, and it's likely that some kind midwife or doctor will be able to communicate with me in English during all stages of this process.

My concerns about bedside manner have been somewhat alleviated, mainly because the midwives I've met aren't nearly as rushed as my doctor is. Occasionally I still come up against what has become my least favorite phrase in any language - "That is not possible," followed by a blank stare - but I'm learning to navigate around it, and find people to help me who are willing to think about possibilities instead of impossibilities.

Next Time
If I'm lucky, and no complications arise, my next installment will be a recap of what actually happened at the hospital and the aftermath. How terrifying. If anything interesting happens before then, I'll post in the interim.

Part One: The Nuts and Bolts of the First Half of Pregnancy
Introduction and Disclaimer


Christina said...

We're currently trying to conceive, but I'm still a bit freaked out by the different system here. Thanks for writing up your experiences, it's helped calm me down... a bit. ;-)

Blythe said...

I'm glad to hear that this info is useful to someone (besides me!). Good luck.

Maria and Kevin said...

I wish you nothing but the best of luck. Reading your blog is interesting to me. I realize that I am in a different city (Frankfurt), and some experiences are the same, but others are completely different (I actually did slip in the bathtub once).

Don't give up on the English speaking midwife that will do all you want. I was lucky and found a great one on the first try (recommended by my doctor), and she is associated with a smaller hospital here, so we simply chose the hospital that she could be at with me. My husband's job could cause him to miss the birth.

Of course, I had to jam all of my learning in to the past 5 weeks and am 4 weeks from my due date, so I needed a lot of luck!

Anonymous said...

As this is an old one, don't know if you'll ever see this comment. I'm American and my wife is German. Our son was born in Dresden 2 years ago. Whoa was that different from when our daughter was born in Chicago 4 years ago. (i) the cafeteria CLOSED FOR LUNCH TIME!! How German can you get??; (ii) the post-birth patient rooms had 4 beds and Dad was clearly not welcome beyond short visits

Kimberly said...
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