Giving birth in Germany

Last Updated on March 27, 2023

Finally we got to the decisive stage of pregnancy – giving birth in Germany. This part is about what things to take with you to hospital, about the labor induction in Germany, pain relief and anesthesia for giving birth and time in the hospital after giving birth.

Part 1 Pregnancy in Germany. 1. Problems before pregnancy
Part 2 Pregnancy check up in Germany. Testing and monitoring
Part 3 Pregnancy in Germany. 3. What is hebamme, how to find her and what is Mutterpass

Prescription in Germany. Red, blue, green prescriptions – when you must pay
State health insurance in Germany what is deductible – from A to LNon-Speaking child. Speech delay treatment in Germany

Giving birth in Germany as a foreigner

If you have health insurance, giving birth in Germany for you free of charge. If you have no health insurance and have no money, you can get a help in social institution such as Malteser.

If this is your first birth in Germany and you don’t speak German very well yet, be sure to bring someone with you who can translate for you. Some husbands don’t want to be present, but foreign women need it. A woman in labor can forget German from pain. In German maternity hospitals, not in large international cities, women are often treated disrespectfully if they cannot respond perfectly to the German language during childbirth. The head of the maternity hospital in Öhringen told me that I should learn German better, when I did not immediately answer him, because I got out of bed and could only think about the pain in my lower back. I also heard ridicule at women who did not understand German. For some reason, the midwifes think that they are not being heard.

How you should get to the hospital

In most cases you should get to the hospital yourself: by car or by taxi.

The exception is when the doctor or midwife said: “If your water breaks within two weeks before our next meeting, you should call an ambulance”: if the baby has not yet descended completely down (somewhere before the 38th week) or is in the wrong position, then when the waters leave, you must immediately lie down and call an ambulance (Liegetransport). After the head of the baby is completely down, this exception no longer applies.

Also, an ambulance should be called in obviously difficult cases, such as heavy bleeding.

Bag to the hospital

What the hospital already has, that is, you don’t need to take it:

• sanitary napkin

• breast pads

• water, tea

• things for the child (that is, you only need things in one exemplar for leaving and you can bring them later, but it’s better to collect them in advance so as not to rely on dad)

What is clearly needed:

• marriage certificate (required for the registry office, you can bring it there), insurance card

• slippers for yourself and your partner

• t-shirt under clothes and socks (in delivery rooms it is often, although not always, cold, so when they start to take off your clothes, it is desirable that something is left)

• dry food for a partner and yourself (a woman in labor is generally fed if the matter delay, but the partner – no)

• comfortable clothes for several days (with the expectation that it can get dirty with blood or milk) – underwear, nursing bras, soft pants (2-3 pieces), sweaters (opening above for women with small breasts, loose to feed from below, for women with large breasts.
  A robe, often on lists, is not the most comfortable clothing, and neither is a nightgown (pajamas are much more practical, for a hospital at least)

• towel, toothbrush, toothpaste

• time-killers (phone, tablet, (e-) book, etc. and chargers for them)

• change of clothes for a partner, if a family room is expected

• a set of things for a child for leaving a hospital, a car seat, warm clothes on top in case of cold weather.

Suspicion of membrane rupture (Blasensprung)

The classic version that everyone imagines with the words “the waters broke” (when a lot of water suddenly flows out) does not always work.

Sometimes a little liquid may appear, and it is not clear what it is at all. In this case, you need to go to the hospital to determine if the fluid is amniotic. If this is the case, you will have to stay in the hospital and receive at least an antibiotic in a vein to protect the fetus from infection, as a maximum – stimulation of labor if the contractions do not start by themselves within a day.

Labor induction in Germany (Geburtseinleitung)

Stimulation is done in cases when:
a woman is overstaying the term,
the water has broken, but there are no contractions,
or the birth has already begun, but the contractions are very weak or have stopped.

The concept of “overstaying the term” is defined differently by all doctors. Term of childbirth is calculated in the vast majority of cases purely arithmetically: we take an average woman with a 28-day cycle and ovulation on the 14th day and consider this day as
the day of conception.
Then we calculate: day of last menstruation + 40 weeks (38 weeks – the duration of human pregnancy + two weeks before average ovulation).

Thus, if you are not an average woman and your cycle is longer, then your term can easily shift by a week, and even more with an unstable cycle. And such pregnant women – about a third. Nevertheless, I have not yet met a doctor who, based on the results of an ultrasound of the fetus or according to information about the cycle, will change the estimated artificial calculated due date.

Then everything will depend on luck – which doctor you will get at the end of pregnancy. Now it has become popular to insist on stimulation even at the slightest delay over the border of 40 weeks, for example, on the basis that a woman is over 35 years old, that is, already old = risky pregnancy.

That is why I do not recommend going to the hospital for “acquaintance” for women over 35 years old, if there are no other risks, except for age. There is a strong psychological pressure: such as the placenta does not work well, the child gains too much weight, and so on. Stay with your gynecologist – until he sees no reason for stimulation, you have nothing to do in the hospital.

The reason for this fashion for stimulation is the belief that many risks can supposedly be avoided in this way. However, there is no evidence for this idea: for at least 41. week, a woman can walk on without any threat to herself or her child, provided that she is under medical supervision (every two days).

But the safety of the stimulation itself is increasingly being questioned, especially since there are no clearly good ways to do it.

It is easy for the maternity hospital to insist on stimulation: they can set a convenient time, the woman is under control and included in the conveyor. Deaths are extremely rare, obvious injuries to children are also extremely rare, and the maternity hospital will never know about non-obvious ones. Such things are not revealed soon and it will only be possible to shrug it off: “Well, who knows now whether the stimulation is to blame.” And even in the event of death and investigation, it is difficult to unequivocally blame stimulation, since it starts an uncontrollable process, and a person dies already from another reason.

Speech therapists and therapists for various developmental disorders do not keep statistics on labor stimulation, they only ask about caesarean section, use of forceps or prematurity. But I know many mothers which had stimulation with children that have speech problems.

I recommend that you properly prepare for the situation of stimulation, since in the maternity hospital they lie keep back very smoothly.

If you want to resist, the following information will come in handy:

• they still need your consent signature, this is your advantage

• read carefully the papers that you are offered to sign: everything is written there in much more detail than they explain orally, do not believe the words “well, it says the same thing that I told you here”. They tell, greatly softening the picture.

• all drug stimulations cause much stronger contractions than during natural childbirth. Often the pain is described as unbearable – this is not an exaggeration.

• stimulation is a poorly controlled or not controlled process at all

• at the same time, it just might not work! After a day of painful contractions, everything subsides and the next day you have to start from the beginning.

• carefully and in advance read everything you can find about stimulation options, stock up on evidence for a dispute. As long as you don’t resist, you are treated like another pawn. As soon as you start arguing, they have to talk to you and hear you. The problem of not being heard is the main problem of hospitals, they fit you to their instructions, their average patient.

What is available for stimulation? A number of folk remedies, gel, tablets, medicine in a vein (only with the existing disclosure).

Folk remedies for labor induction

When using folk remedies, you must clearly understand: you can only stimulate what is already there. Multiplying zero gives zero!

The following folk remedies are considered as not harmful to health and theoretically helping:

• walks, especially uphill

• climbing stairs

• warm (not too hot) bath

• sex

• cleaning the house

All this without fanatism and extrems.

Cocktail with castor oil (Rizinusöl-Cocktail)

I singled out this remedy separately: it is folk, but hospitals do not hesitate to use it.

“Cocktail” consists of 2 tablespoons of castor oil, 2 tablespoons of almond mousse, 2 drops of verbena oil, a third of a liter of apricot juice, a spoonful of champagne (!). All this must be mixed with a mixer.

Castor oil causes excruciating diarrhea and, to say the least of it, is not considered safe. Its effect on pregnant women has not really been studied. The German Medicines Commission does not recommend the use of castor oil for stimulation:

• firstly, there are doubtful deaths when castor oil stimulation ended in the death of the woman in labor. These deaths cannot be unambiguously attributed to castor oil (the official cause is some kind of heart failure), but they should not be ignored either.

• secondly, castor oil can get to the fetus – which can cause meconium aspiration

• thirdly, even if nothing bad happens, the woman in labor will be completely weakened by diarrhea, nausea, and often also vomiting.

• fourth, this cocktail may not work! So “stimulation” will go into the category of torture for the woman in labor.

Medicines Commission Source – www.akdae.de There, in the search, we type riziniusöl and the first number is the commission report, where there is also a page on castor oil

Medicines for labor induction in Germany

The use of any of these agents is an indication for PDA. After a caesarean section, stimulation with these agents is not recommended, and pills should definitely not be used at all in order to avoid uterine rupture.

Gel

The gel with the hormone prostaglandin (Prostaglandine), which serves to “maturation” the cervix, acts slowly. If it works on the first day, you are lucky. After applying the gel, you need to lie for an hour on the CTG.

What is bad with gel:

• acts slowly, there is a high probability of reapplying the next day

• they make a lot of painful internal sensations

• contractions are much more painful (the level of contractions will not correspond to the level of pain experienced) than natural

Pils

UPD. From April 2020, Cytotec should not be used in Germany! They got the Rote Hand from the oversight organization

Cytotec tablets with the hormone Misoprostol, which is also like a prostaglandin, are not sold in Germany and are not approved for use. You accept them at your own risk and sign a paper about it.

Recently, information has appeared that a number of children and women in labor have suffered from the use of these pills. There are class action lawsuits in various countries over the harm caused by stimulation with these pills. I can say that I consider myself and my son also a victim: our case of child speech impairment just fits perfectly into the picture outlined in the articles. Of course, it is no longer possible to bring anyone to responsibility and the case from the “Who knows” series, but everything coincides too well.

Read about speech impairment of children: diagnoses, what to do in Germany.

What is bad with pills:

• they can’t be controlled, so it’s easy to overdose

• they cause unbearably painful contractions, leading to meconium shedding by the baby, lack of oxygen, and potentially brain damage.

The Ministry of Health warns that Cytotec should not be used by women at any stage of pregnancy as it may cause miscarriage or damage to the fetus. I don’t understand how, in the absence of proper research, these pills can be offered in the last week of pregnancy – are they doing a “chemical abortion”?

An excerpt from the commission’s decision:

Misoprostol ist bei schwangeren Frauen kontraindiziert, da Misoprostol Uteruskontraktionen induziert und mit Abort, Frühgeburt, Totgeburt und fetaler Fehlbildung in Zusammenhang gebracht wird. Bei Schwangerschaften mit Exposition gegenüber Misoprostol im ersten Trimenon wurde über ein etwa 3-fach erhöhtes Risiko für Fehlbildungen berichtet, im Vergleich zu einer Inzidenz von 2 % in der Kontrollgruppe. Eine pränatale Exposition gegenüber Misoprostol wurde insbesondere mit Möbius-Syndrom (angeborene Fazialisparese mit Hypomimie, Saug- und Schluckproblemen sowie Störungen der Augenbewegungen mit oder ohne Fehlbildungen an Gliedmaßen), Amniotisches-Band-Syndrom (Deformation von Gliedmaßen/Amputationen, insbesondere Klumpfuß, Acheirie, Oligodaktylie, Gaumenspalte usw.) und Anomalien des zentralen Nervensystems (zerebrale und kraniale Anomalien, wie Anenzephalie, Hydrocephalus, Kleinhirnhypoplasie, Neuralrohrdefekte) in Verbindung gebracht. Es wurden auch andere Defekte einschlieülich Arthrogrypose beobachtet.

Oxytocin in a vein (Oxytozin or Wehentropf)

Oxytocin is used only when the cervix is open at least 2 cm. The main disadvantage of oxytocin is severe painful contractions. Therefore, oxytocin is used (by normal doctors) together with anesthetize.

Anesthesia for giving birth in Germany

It is common knowledge that different people perceive pain differently. But they do not know about it in maternity hospitals.

But for some reason, women in labor are often denied the right to feel too much pain. Something like “And why shout, it would be better if she saved her strength and did not deprive the child of air, it is quite possible to be patient” – this is still a polite option – I have heard it repeatedly. Generally speaking, a person does not scream for here own pleasure. And anesthesia is not a whim, but a way to preserve one’s own dignity and health, because excessive pain deprives one of control over the body, deprives one of the ability to be aware of what is happening. Excessive pain can lead to a variety of bad consequences for the child and mother.

Local hebamms are very fond of expressing the idea that, they say, if a woman has not gone through pain, then she may have problems with self-esteem and perception of the child. And what about the psychological trauma of too painful childbirth?

You must clearly understand that German hebamme are fans of exclusively natural childbirth. They lack the empathy/knowledge to understand that this is not for every woman and can hurt a lot. They will never ask you if you want anesthesia. You must demand it!

As long as the pain is such that a woman is able to move and can control her body, all these obstetric things that they talk about so much are available to her:

• breathe properly

• massage

• choose a position (for which all these balls and Swedish walls are placed in the birth rooms and scarves hang)

• to take a bath

• move

But all this is exactly as long as a woman can stand, and not writhe in pain. If this “writhing” begins only on the last centimeters of cervix opening and the process goes quickly, then it can still be endured, but if hours of painful contractions are behind and especially if there was stimulation, then it is better to demand medical anesthesia.

What they can offer:

• suppositories. The main active ingredients are paracetamol and antispasmodics. They do not have any special effect on strong contractions, they are suitable only for the first period of contractions.

• opiates (Opiat Pethidin (Dolantin)). They reduce pain, but most importantly, they cloud the mind, from which the contractions seem to pass by. Opiates are not the safest medicine at all, but if PDA is not given, then at least they should be.

• epidural anesthesia (Periduralanästhesie, PDA)

One of the safest and most convenient type of anesthesia, which midwives in Germany clearly do not like. In small maternity hospitals, they will do everything to tell you “It’s too late!” And they certainly won’t offer it. For midwives, PDA is inconvenient because a woman may not feel anything at the stage of attempts, and then the midwife must completely manage this stage. In addition, contractions can become weaker from PDA, and then you need to add a little oxytocin and monitor it. Of course, it is much easier to leave a woman screaming in pain at her husband and occasionally check how the dilatation is.

For a woman, PDA is inconvenient mainly because it must be decided in advance:

– to demand in advance (!) papers for the anesthesiologist.

– demand in advance (!) that they take blood and put “Zugang” (port) into a vein.

– remove excess clothing from above, leave only a loose T-shirt (the back is sealed with plasters to bring the entrance for anesthesia up)

You need to tell about your desire to each shift of doctors and midwives, they do not transfer information about your desires to the next shift.

Otherwise, you can run into such a real case.

The woman is already writhing like a worm from almost constant contractions and requires PDA, and the midwife happily begins to say: – Well, this is not the first birth, you will have to be patient, the contractions are, of course, strong, but so far everything is with the child well, think positively, but PDA has its drawbacks…

Woman in labor: – To hell with the drawbacks, I demand anesthesia!

After five minutes of such a discussion, interrupted by screams, the midwife: – Do you know, but it was necessary to give blood, so you are already late!

Woman in labor: – And I gave blood yesterday, I was exhausted for 7 hours stimulation yesterday and 15 hours today, it’s enough for me, give anesthesia !!!

Midwife: how much dilation do you have, only 2 cm? And you are already screaming like that? well, so be it, perhaps you really need to … Only fill out the papers first (in small print on two pages). You can not? well, let the husband fill in. As soon as it’s full, I’ll call the anesthesiologist.

The anesthesiologist, who came half an hour later, could hardly put the PDA, since it requires the woman in labor not to move and relax, and in conditions of constant painful contractions, this is on the verge of being possible. His main question was: why the hell did they wait so long?

Although theoretically PDA is offered in all maternity hospital, I recommend going to a large hospital for it. In Germany, only 20 percent do anesthesia (in other countries – up to 50 percent) – with such an attitude of midwives, this is not surprising.

After childbirth

After childbirth, stitching (if required) and child care (weight, height, blood from the umbilical cord) follow. You will have to spend in the delivery room for the procedures and just waiting for about 2 hours.

You need to spend three or four days in the hospital. Many prefer to pay for a family room (about 80 euros per night) if one is available. If there are more rooms in the hospital than there are women in labor, it is not uncommon for them to simply push two beds together. In addition to lodging for the night, the father is also entitled to hospital meals. In the case of prolonged stimulation or difficult childbirth, the family room is not a luxury, but a necessity: otherwise, the future dad, in 2 days of hunger and lack of a sleep, can throw back his hooves before the baby appears.

Hospital services include:

– first examination of the child (U1)

– vitamin K for baby

– analysis for genetic diseases and also a hearing test

– breastfeeding advice

– training in child care (navel, rubdown)

– helping a mother with pain, chest injuries

– on the day of discharge, the second examination by a pediatrician (U2)

Do you have any more questions? Use comments ⇓ or private communication form ⇨

A couple of tips (some of them have changed over the past 10 years to the exact opposite):

– now it is not recommended to wash the child often – only to wipe. Bath – no more than once a week.

– it is recommended to use as little care products as possible – preferably only water

– modern milk formulas are used in breastfeeding mode – on demand. Formula Pre is very close to mother’s milk and can be used throughout the first year without switching to other formulas.

– with jaundice – breastfeed as often as possible

– the level of jaundice is now checked not according to the color table and not by the measuring apparatus, but by blood, since the color of the skin does not correspond to the level of bilirubin in the blood. At a level of 18-20, the child is sent under a lamp to the hospital for a couple of days. Under the action of light, bilirubin breaks down and is excreted by the kidneys. In addition, saline is dripped in order to be better excreted, no more drugs are given.

Upon discharge from the hospital, you are entitled to a daily hebamma visit for 10 days and 16 more visits over the next 12 weeks. Read more about hebamme in part 3. Immediately after returning home, it is advisable to take terms for U3 from a pediatrician and a gynecologist.

Part 1 Pregnancy in Germany. 1. Problems before pregnancy
Part 2 Pregnancy check up in Germany. Testing and monitoring
Part 3 Pregnancy in Germany. 3. What is hebamme, how to find her and what is Mutterpass
All medical topics – #medicine